RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:
BRANCH OF SERVICE: ARMY

CASE: PD-20 18-00514
SEPARATION DATE: 20061222

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active duty E2, M edical Logistics Specialist, med ically  separated  for "bilat eral shin splints" with a disability rati ng of 0%.

Cl CONTENTION: " I was med boarded for shin splints when other medical issues were present, specially a back issue." 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 Physical Evaluation Board (PEB) to be unfitting for continued milit ary service, and when specifically requested by the Cl, those conditions identifi ed by the Medical Evaluation Board (MEB), but determined by the PEB to be not u nfi tting or no n-compe nsable. Any conditions outside the panel' s defined scope of review, and any contention not requested in this app licatio n, may remain eligib le for future consideration by the Board for Correction of Military Records. The panel' s authority is limite d to assessing the fairness and accuracy of PEB rati ng determinations and recommending corrections when appropriate. The panel gives consideration to VA evidence , particularly within 12 mont hs of  separation, but  only to  the extent that it reasonably reflects the severity of disability at the time of separation.

RATINGCOMPARISON:

SERVICE PEB • 20061129	VARD • 20070207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splint s	5022	0%	Shin Splints, Left Leg	5022	10%	20061209	
			Shin Splints Right Leg	5022	10%	20061209	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Bilateral Shin Splint. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the Cl' s bi lateral shin splint condition began in February 2006 while running during physical tra ining. The shins became swollen and painful with a cramping feeling. Treatment included nonstero ida l anti-inflammatory medication and a temporary profile, but  pain continued. In April 2006, X-rays were interpreted as normal, however, a bone scan the  same mo nth revea led severe stress changes in the left dist al tibia and bilateral shin splints. The Cl was able to complete his advanced infantry training while being treated with physical therapy and an extended temporary profile, however, the bilatera l shin pain continued. In October 2006, orthopedics noted tenderness in the t ibial shafts of both legsand recommended a permanent L3 profile and an MEB. Treatment recommendations in cluded conservative treatment with anti­ inflammatory medication and activity restrict ion. Surgery was not indicated.

During the 19 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the physical examination revealed tenderness in the distal one-third of the tibia bilatera lly, left greater than right, without swelling or atrophy. There was tenderness to the inst ep bilatera lly without swelling or atrophy. The 1 November 2006 MEB NARSUM

examination, one month prior to separation, noted complaints of significant difficulty with prolonged standing and inability to ruck march. The CI was able to perform the basic activities of daily living but reported he no longer ran for fitness and pleasure or played football. He reported significant difficulty with climbing stairs. According to AMA pain rating guidelines, the pain was slight and frequent. Physical examination was as described in the MEB examination. The CI also showed a slightly antalgic gait and no neurologic deficits were noted.

At the 9 December 2006 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported pain located at the shins for 9 months. The pain was present constantly, elicited by physical activity, and relieved by rest. With pain, the CI required bed rest. There was pain during and after exercise. He reported he could barely walk. Treatment included Ibuprofen, Celebrex, and Feldene. There was no functional impairment. X-rays of the right tibia and fibula showed normal mineralization. Physical examination showed tenderness of the left and right tibia respectively with palpation of the anterior tibia. Gait was within normal limits. Range of motion (ROM) of the right and left knees bilaterally showed flexion to 130 degrees (normal 140) with pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the shin condition 10%, coded 5022 (periostitis). The PEB cited “without documented limitation of motion.” The based the rating on the C&P examination, citing painful or limited motion of a major joint or group of minor joints. The panel first considered whether the left and right shin splint conditions remained separately unfit, having been de-coupled from a combined PEB adjudication. In this case, bilateral shin splint pain was profiled and the MEB determined the shin splints condition failed retention standards. The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to one foot over the other. Since undue speculation would be required to conclude that impairment from either foot would not have unacceptably interfered with the performance of military duties, members agreed that each foot was reasonably justified as separately unfitting. MRI endorsed bilateral shin splints.

The panel then considered its rating recommendation for the shin splints at the time of separation. In this case, evidence indicated the right and left lower extremity were equally symptomatic and both were profiled coded L3. Examination findings were essentially the same in both, with evidence of stress fractures of the right and left legs. Examinations showed non- compensable ROM. Radiographic studies documented bilateral pathology and the MEB NARSUM and C&P examinations documented painful motion of each leg. According to IAW VASRD §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. Although conservative treatment had been provided, there was persistent pain in both the right and left extremity that interfered with work and was individually unfitting. The panel agreed that separate disability ratings of 10% each were warranted for the right and the left leg conditions. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right and left leg respectively condition, coded 5022.

Contended PEB Condition: Plantar Fasciitis. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the plantar fasciitis condition, so no additional disability rating is recommended.

BOARD FINDINGS: In t h e matt er of the left shin splint condit ion, the panel recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71. In the matter of the right shin splint condit ion, the panel recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71. There are no ot her condit ions wit hin the panel' s scope of review for consideration.

The panel recommends the Cl' s prior determinat ion be mo difie d as follows, effective the date of med ical separation:

CONDITION	VASRDCODE	PERMANENT RATING	
Left Shin Splint	5022	10%	
Rig ht Shin Spli nt	5022	10%	
	COMBINED	20%	

The following documentary evidence was considered:

AR20200005547,

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

Dear

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.