RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05533
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Criminal Investigation Division Special Agent, medically separated for “chronic bilateral lower extremity (BLE) pain” with a disability rating of 0%.

CI CONTENTION: In addition to the BLE condition, the CI also requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20070717	VARD - 20080401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic BLE Pain	5099-5003	0%	Left Leg, Posterior Tibialis Tendinitis	5299-5262	0%	20071114	
			Right Leg, Posterior Tibialis Tendinitis	5299-5262	0%	20071114	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic BLE Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic BLE pain began in September 1997 during basic training. Conservative treatment did not resolve the pain and the CI was referred to orthopedics. A 1998 bone scan showed inflammatory changes in the distal femur, tibia, calcaneus and right mid-foot. A diagnosis of bilateral stress fractures was rendered. The CI was pregnant in 1999 and stopped running, which resulted in an improved bone scan. But after return to her unit and to running in March 2000, the pain returned. In late 2006, the symptoms worsened. During the 17 April 2007 orthopedics examination, 5 months prior to separation, the CI reported pain in the bilateral tibiae, joint of the great toe, anterior mid feet and hips with physical activities. Physical examination showed tenderness in the corresponding areas. The physical therapy range of motion (ROM) examination of the knees, a week and a half later, showed bilateral flexion of 130 degrees (normal 140) and bilateral extension of 0 degrees (normal). The examiner did not note painful motion or gait abnormalities. The 18 May 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of persistent BLE pain.

At the 14 November 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported LE pain from the hips and pelvis to the feet and toes. The pain occurred intermittently up to four to five times per week and lasted a few hours each time. Her LE pain was elicited by physical activity and prolonged standing. She could perform activities of daily living, but was currently unemployed and pregnant. Physical examination of the extremities showed tenderness over the right greater than left hip and mild tenderness over the lower medial third of the lower legs bilaterally. There was mild tenderness over the lower tibiae with no instability or bony deformity. Leg length was equal and feet showed no signs of abnormal weight bearing. The CI had a wide-based gait, but this was noted to be due to pregnancy. She did not require assistive devices for walking. The knees showed evidence of crepitus, but had normal ROM. Repetitive motion of the left and right knees showed pain starting at 100 degrees, but normal ROM was preserved, and joint function was not limited by fatigue, weakness, lack of endurance, or incoordination for either knee. The right hip showed guarding of movement due to pain on motion. The CI also had difficulty going from sitting to standing and there was pain with exercise. Ankle examination showed mild tenderness over the dorsum and anterior ankle, normal ROM, and pain-limited function bilaterally after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB combined the left and right LE conditions as a single unfitting condition analogously coded 5099-5003 (degenerative arthritis) and rated 0%, citing constant and minimal pain IAW the US Army Physical Disability Agency pain policy. The VA rated posterior tibia tendinitis of the right and left knees 0% each, analogously coded 5299-5262 (impairment of tibia and fibula), based on the C&P examination, citing that although there was some painful motion, there was no objective evidence of functional impairment or limitation of motion. Panel members considered the somewhat disparate examinations and agreed the pre-separation examinations were more consistent with historical evidence from the STR for the CI’s long-standing LE pain. The panel also considered it was reasonably justified to consider the left and right LE conditions as separately unfitting. The pre-separation examinations did not document painful or limited motion of the LE joints, abnormal gait, atrophy of the lower extremities, or increased symptoms with repetitive motion. The panel reviewed the medical evidence for the hips, knees, feet, and ankles and could not find any ratable evidence that would result in a rating higher than the combined 0% as determined by the PEB. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the BLE condition.

BOARD FINDINGS: In the matter of the bilateral lower extremity condition and IAW VASRD
§4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

2	PD-2017-05533

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.