RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE NUMBER:  PD1201274
BRANCH OF SERVICE:  Army	BOARD DATE:  20130404
Separation Date:  20021010

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty PFC/E-3 (52D10/Power Generation Mechanic), medically separated for chronic right lower leg pain.  The CI’s bilateral shin pain developed during advance individual training (AIT) in October 2001.  Despite continued use of crutches, upper/lower body nautilus training, soft-shoe profile, pool rehab, orthopedic treatment and medications, the CI failed to meet requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued an L3 Profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “chronic right lower leg pain” to the Physical Evaluation Board (PEB).  The MEB forwarded no other conditions for PEB adjudication.  The PEB adjudicated the “chronic right lower leg pain with no evidence of edema or muscular weakness” condition as unfitting, rated 0 percent, with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated with a 0 percent disability rating.  

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

SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions determined by the PEB to be specifically unfitting for continued military service or when requested by the CI, conditions “identified but not determined to be unfitting by the PEB.”  The rating for the unfitting condition (chronic right lower leg pain) is addressed below.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, is eligible for consideration by the Army Board for Correction of Military Records (ABCMR).  

RATING COMPARISON:  

Service IPEB – Dated 20020813	VA (1 Mos. Pre-Separation) – All Effective Date 20021011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic right lower leg pain	5099-5003	0%	History of a stress fracture of the right tibia with shin splints	5022	10%	20020925	
↓No Additional MEB/PEB Entries↓	0% X 0 / Not Service-Connected x 0	
Combined:  0%	Combined:  10%	

ANALYSIS SUMMARY:  The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Military Disability Evaluation System (MDES) fitness determinations and rating decisions for disability at the time of separation.  The Board utilizes service and VA evidence proximal to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for special consideration of post-separation evidence.  Post-separation evidence is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Chronic Right Lower Leg Pain Condition.  The range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation, as summarized in the chart below.  

Right Lower Leg ROM	MEB NARSUM ~4.5 Mo. Pre-Sep	TMC ~3 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
Flexion (0-125⁰)	FAROM	FAROM	No ROMs	
Extension (0-20⁰)				
External Rotation (0-45⁰)				
Abduction (0-45⁰)				
Adduction (0-45⁰)				
Comment	Tenderness to palpation (TTP) along medial aspect of right mid 1/3 tibia	Gait nml; TTP mid 1/3rd right tibia; 
“pain with standing for long periods”	Gait and stance normal;  exquisite TTP mid shin area and medially; Homan’s sign neg 	
§4.71a Rating	10% (MEB 0%)	10%	10%	

A bone scan in October 2001 indicated bilateral shin splints with superimposed grade I stress fracture of the right mid tibia.  The CI continued with the right shin pain and stress changes in the right foot.  A right leg X-ray in May 2002 was negative.  An orthopedic examination also in May 2002 documented a right lower extremity stress injury and the examiner opined that there was no anticipated recovery that would return the CI to potential 5-day-per-week physical training.  The CI was issued an L3 Profile for chronic lower leg pain (shin splints) with restrictions of no running, jumping, marching, no rucksack and no lifting greater than 30 pounds.  The commander’s statement indicated that the CI was unable to perform the common duties expected of all soldiers.  The MEB Narrative Summary (NARSUM) examination approximately 4 months prior to separation indicated that the CI was limited to walking at his own pace and distance and was unable to run, jump, road march, or rucksack.  The NARSUM physical exam findings are summarized in the chart above.  The CI was seen in the medical clinic approximately 2 months prior to separation for chronic right lower leg pain caused by shin splints which prevented the CI from standing for long periods of time.  The medical clinic physical exam findings are summarized in the chart above.  The VA Compensation and Pension (C&P) examination noted that the CI had significant pain from a shin splint when running with a rucksack and performing other activities which caused interference with his usual soldiering duties.  The examiner opined that the severe shin splint gave the CI a significant amount of physical impairment which necessitated him being medically discharged.  The C&P physical exam findings are summarized in the chart above.   

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the chronic right lower leg pain condition analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) rated 0 percent IAW the USAPDA pain policy.  The VA coded the history of a stress fracture of the right tibia with shin splints condition 5022 periostitis rated 10 percent based on painful or limited motion of a major joint or group of joints.  The orthopedist indicated that the severity of the right lower extremity stress injury prevented any potential for recovery to full duty.  The NARSUM noted that there was limited walking and an inability to perform fitness activities due to the shin splint.  The C&P exam documented significant shin splint pain that prevented the performing of routine soldiering activities.  All three examinations discussed above document the same findings and all support a 10 percent rating based on VASRD §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 reasonable doubt, the Board recommends a disability rating of 10 percent for the chronic right lower leg pain condition.  

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 discussed above, PEB reliance on the USAPDA pain policy for rating the chronic right lower leg pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right lower leg pain condition, the Board unanimously recommends a disability rating of 10 percent, coded 5099-5003 IAW VASRD §4.71a.  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 Right Lower Leg Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120713, w/atchs
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 AR20130009498 (PD201201274)

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