RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX 	CASE:  PD-2021-00044
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Medical Logistics Specialist, medically separated for “bilateral leg pain” with a disability rating of 0%.   

CI CONTENTION:  He felt the determination was rushed, and he was told the VA would get him a higher rating.  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 military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (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 - 20070426	VARD - 20071213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Leg Pain…	5099-5003	0%	Shin Splints, Left Lower Leg	5299-5262	10%	20070910	
			Shin Splints, Right Lower Leg	5299-5262	10%	20070910	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Leg Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral leg [shin splints] condition began in 2000 during a prior active duty enlistment when he first sought treatment.  He completed his obligation and was discharged in 2002.  He re-enlisted in September 2005 after an almost 4-year break in service, symptoms recurred and gradually worsened with running.   Bilateral leg X-rays in April 2006, and MRI in June 2006 were normal.

During the 8 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported pain in both legs since 1999, aggravated by recurring prolonged walking.  Physical examination revealed tenderness about the pretibial surface and the anterolateral and medial sides of both legs.

The 8 March 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral leg pain, worse early in the morning and in the evening.  His pain worsened with walking over a mile or running.  Physical examination showed no evidence of effusion or instability.  He could walk on his toes and heels.  Patella tracking was normal, and compression of the patellofemoral joints did not cause pain.  Bilateral knee range of motion (ROM) was 0-140 degrees (normal).  Soreness was noted about the medial, lateral and tibia, bilateral legs. There was 15 degrees of dorsiflexion (normal 20), and 30 degrees of plantar flexion (normal 45), bilaterally, but painful motion was absent.

At the 10 September 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported increase bilateral leg pain with activity such as prolonged walking, or driving of greater than an hour.  He stated that the right leg was slightly worse than the left. Physical examination showed full knee ROM, no evidence of inflammation or instability.  He had 15 degrees of dorsiflexion and 30 degrees of plantar flexion bilaterally, with absence of painful motion.  There was some tenderness in the mid tibial shaft bilaterally.  The examiner made no mention of one leg being worse than the other. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled and rated the bilateral leg pain condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA addressed each leg separately, rating the right leg pain condition and left leg pain condition 10% each, both analogously coded 5299-5262 (impairment of tibia and fibula), based on the C&P examination, citing “despite your full range of motion, 10% evaluations are warranted based on your reports of discomfort and pain…along with the examiner noting bilateral mid-tibial shaft leg pain.” 

Panel members first considered whether the right and left leg conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  The panel noted that the objective findings and associated disability for each leg were similar and that the respective ratings should be separate but also the same.   Panel members agreed, there was no limitation of motion which attains a minimum rating under the diagnostic codes for limitation of flexion (5260) or extension (5261).  Likewise, there was no evidence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  However, the panel agreed, a 10% rating and no higher was justified for slight impairment knee or ankle disability (5262) of each lower extremity demonstrated by the finding of tenderness about the tibias, limitation of ankle ROM at the NARSUM and the C&P exams, and functional loss due to pain, recorded at the MEB, NARSUM and C&P examinations.  Although the ankle ROM was limited not by pain, the condition reasonably caused functional loss and some limitation of motion, supporting application of §§4.59 and 4.40.  However, panel members agreed, the CI’s condition was best reflected in the 5262 coding scheme.  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for each leg condition, coded 5299-5262.  

BOARD FINDINGS:  In the matter of the right and left leg pain conditions, the panel recommends a disability rating of 10% each, with both coded 5299-5262 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Leg Pain	5299-5262	10%	
Left Leg Pain	5299-5262	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20210408, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20210017094, XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 

Sincerely,