RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	BRANCH OF SERVICE:   Army
CASE NUMBER:  PD1200542	SEPARATION DATE:  20011012
BOARD DATE:  20130418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (19D/Cavalry Scout) medically separated for chronic bilateral leg pain.  He began having leg pain during basic training.  He was treated, but did not improve adequately to fully perform his military training or meet physical fitness standards.  He was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB).  The MEB found his bilateral leg condition medically unacceptable, and referred him to a Physical Evaluation Board (PEB).  No other conditions were forwarded for PEB adjudication.  The PEB found the chronic bilateral leg pain unfitting, and rated it 0% IAW the US Army Physical Disability Agency (USAPDA) Policy Guidance Memorandum #13, subject: Rating Pain.  The CI made no appeals, and was medically separated with 0% disability.

CI’s CONTENTION:  The CI elaborated no specific contention in his application.  

SCOPE OF REVIEW:  The Board’s scope of review as defined in DoDI 6040.44, is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The unfitting leg condition (chronic leg pain due to bilateral tibial stress fractures) meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below.  No other conditions are within the Board’s purview.  Any condition outside the Board’s defined scope of review may be eligible for future consideration by the respective Service Board for Correction of Military Records.

RATING COMPARISON:

Army PEB – dated 20010925	VA  – All Effective 20011013	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Leg Pain, due to Bilateral Stress Fractures	5099-5003	0%	Right Tibial Stress Fracture	5099-5014	10%	STR	
			Left Tibial Stress Fracture	5099-5014	10%	STR	
↓No Additional MEB/PEB Entries↓	Not Service Connected x 1		
Combined:  0%	Combined:  20%	

ANALYSIS SUMMARY:

Bilateral Leg Pain.  In April 2001, the CI began having bilateral leg pain.  His leg pain was increased with walking or prolonged standing.  A bone scan showed increased uptake in the posterio-medial area of both tibias, the left greater than the right.  Due to his persistent bilateral leg pain, an MEB was initiated.  The MEB clinical evaluation was in September 2001, one month prior to separation.  Examination revealed tenderness to palpation (TTP) of both tibias.  Both legs were neurovascularly intact.  There was full range-of-motion (ROM) of the knees and ankles.  He separated from the Army on 12 October 2001.

The Board carefully reviewed all of the evidentiary information available.  The PEB combined the two leg pain conditions into a single unfitting condition characterized as: “Chronic leg pain due to bilateral stress fractures.”  The condition was coded 5099-5003, and rated at 0%.  The VA unbundled the two leg conditions, and assigned a rating of 10% to each leg, resulting in a combined rating of 20%.  The Board evaluated whether or not it was appropriate for the two leg problems to be “bundled” together.  The Board must determine if the PEB’s approach of combining the conditions under a single rating was justified in lieu of separate ratings.  The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD).  If the Board judges that two or more separate ratings are warranted, however, it must satisfy the requirement that each ‘unbundled’ condition was separately unfitting.  After due deliberation, the Board determined by majority decision (2:1 vote) that the evidence does not support a conclusion that each of the leg pain conditions, separately, would have rendered the CI unable to perform his required military training.  Accordingly, the Board does not recommend a separate disability rating for each leg.  It is appropriate for the two legs to be bundled together and treated as a single unfitting condition.

The Board determined that the most appropriate diagnostic code for the chronic leg pain condition was 5099-5022 (analogous to periostitis).  Since there was no loss of motion, the leg pain condition was essentially non-compensable based solely on VASRD §4.71a.  However; IAW VASRD §4.40 (Functional loss), a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt) and VASRD §4.7 (Higher of two evaluations), the Board recommends by majority decision (2:1 vote) a disability rating of 10% for the chronic bilateral leg pain, due to bilateral tibial stress fractures.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As noted above, PEB reliance on the USAPDA pain policy was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic bilateral leg pain, the Board recommends by majority decision (2:1 vote) a rating of 10%, coded 5099-5022, IAW VASRD §4.40 and §4.71a.  The single voter for dissent (who recommended 10% for each leg, for a combined rating of 20%) did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Leg Pain, due to Bilateral Tibial Stress Fractures	5099-5022	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120604, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130011123 (PD201200542)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA