RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02333
BRANCH OF SERVICE:  Army	BOARD DATE:  20140630
SEPARATION DATE:  20050825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (42L3O/Administrative Specialist) medically separated for bilateral shin splints.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Bilateral tibial periostitis was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions.  The Informal PEB (IPEB) adjudicated bilateral tibial periostitis as unfitting, rated 0%, with VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI appealed to the President of the IPEB and the US Army Physical Disability Agency reaffirmed the IPEB’s finding and rating.

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

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting bilateral tibial periostitis condition is addressed below.  The not-unfitting migraine headaches and scalp alopecia conditions were not contended; and are not within the Board’s purview.  These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service USAPDA – Dated 20050518 | VA* - (2.5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bilateral Tibial Periostitis | 5022 | 0% | Muscle Strain, Lower Extremity, Bilateral | 5299-5262 | 0% | 20051109
Other x 2 (Not in Scope) | Other x 9 | 20051109
Combined:  0% | Combined:  40%
*Derived from VA Rating Decision (VARD) dated 20060125 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Bilateral Tibial Periostitis.  Absent a history of direct trauma, the CI developed anterior bilateral lower leg pain, aggravated with running in early 2003.  X-rays and bone scan were normal.  With progressive painful symptoms, she was diagnosed with bilateral shin splints.  Orthopedics specifically identified bilateral tibial periostitis.  Despite treatment to include medication, altered activities, physical therapy and orthotics, her symptoms worsened with walking or prolonged driving.  Her description of the pain included “excruciating” and “unrelenting.”  Her conservative treatment continued and she was referred to an MEB.  Her limitations included no running, biking, swimming or walking and the commander’s statement corroborated such limitations.  At her MEB narrative summary (performed 5 months pre-separation); she reported an inability to utilize an exercise bike or ski machine without significant pain.  Her physical examination was detailed and normal.  The examiner diagnosed bilateral tibial periostitis, likely based upon historical evidence and not on current objective exam findings.

At the VA Compensation and Pension (C&P) exam approximately 2 months after separation, the CI reported constant shin splint pain since 1994 which was aggravated by driving.  The C&P examination demonstrated a normal gait and radiating tenderness about both medial shins extending from a “possible” “tarsal tunnel syndrome” (TTS - a nerve compression about the ankle bone area).  The examiner’s diagnosis was a muscle strain of the legs secondary to the TTS.

The Board directs its attention to its rating recommendations for the bilateral shin splint condition and debated several options for coding and rating.  The PEB and VA chose different coding options for the condition, but this did not bear on rating and both were IAW §4.71a.  The PEB chose to bundle the lower extremities and assign a rating of 0% with the 5022 code (periostitis) which defaults to code 5003 (arthritis, degenerative) based on residual pain with no limitation of motion.  The original VARD also chose to bundle and assign 0% rating with an analogous code to 5262 (impairment of tibia and fibula), citing “no significant abnormalities in the lower extremities.”

Board members first acknowledged and discussed the lack of “definitive” and “objective” evidence as to the basis of both the service and VA’s diagnoses.  The MEB’s diagnosis of bilateral tibial periostitis was strictly based on historical information and in light of a normal examination, the PEB’s 0% rating was appropriate.  Additionally, the VA’s diagnosis of muscle strain was based upon a “possible” diagnosis of another complete and totally different pending medical condition of tarsal tunnel syndrome.  Furthermore, the VA examination did not elicit any associated abnormal muscular findings or secondary pain as one would expect in a bilateral muscle strain condition.  The VARD’s comment of “no significant abnormalities in the lower extremities” clearly indicated the minimalist of any symptom severity that may have been present and is consistent with recovering from a prior clinical process.  Although both examinations indicated normal range-of-motion without comment in regards to any degree of painful motion, Board members considered a rating of shin splints conceding §4.40 (a part which becomes painful on use must be regarded as seriously disabled), based upon the CI’s reported complaints of pain (excruciating or unrelenting) upon use as indicated by walking, driving, use of exercise bike or ski machine.  The Board deliberated three recommendations which are all compliant with VASRD §4.71a: 1) A bilateral rating of 10% conceding §4.40 and coded 5022 (periostitis); 2) Separate 10% ratings, coded with analogous code 5262 (tibia and fibula, impairment of) for the rating of shin splints also conceding §4.40; 3) Separate non-compensable ratings under 5022-5003 without the fairly tenuous application of §4.40.  Neither the MEB nor the VA demonstrated objective evidence that suggested functional loss due to pain or flare-ups, which would provide for additional or higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends (option #1 above); a disability rating of 10% for the bilateral shin splints 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the bilateral tibial periostitis condition, the Board unanimously recommends a disability rating of 10%, coded 5022 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 her prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Bilateral Tibial Periostitis | 5022 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131106, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150002581 (PD201302333)

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						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-02333