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AF | PDBR | CY2012 | PD2012 00955
Original file (PD2012 00955.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1200955
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130521
SEPARATION DATE: 20020108


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SR/E-1 medically separated for bilateral lower leg conditions. During basic training, the CI experienced bilateral shin and right thigh pain after physical exercise. She completed a 10 week course of rehabilitation only to re-aggravate her condition subsequent to physical testing. Consequently, her condition could not be adequately rehabilitated to meet the physical requirements of her rank or satisfy physical fitness standards. She was placed on light limited duty and referred for a Medical Evaluation Board (MEB). The bilateral lower leg conditions, characterized as “bilateral tibial periostitis” and “right femoral stress fracture,” were forwarded to the Physical Evaluation Board (PEB). No other conditions were submitted by the MEB. The PEB adjudicated “bilateral tibial periostitis” and “right femoral stress fracture” as unfitting, rated 10% and 10%. The CI made no appeals, and was medically separated.


CI CONTENTION: “Plantar fasciitis worse, unable to walk long distances or stand for several hours at a time.”


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 and right femoral stress fracture conditions are addressed below. The CI contention for plantar fasciitis is not within the DoDI 6040.44 defined purview of the Board as this condition was not recognized by the PEB. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20011207
 VA - (1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Tibial Periostitis
 5022-5003 10% Bilateral Shin Splints 5022 0% 20011128
Right Femoral Stress Fracture
 5003-5255 10% Stress Fracture, Right Femur 5299-5255 10% 20011128
No Additional MEB/PEB Entries
 Other x 1 20011127
Combined: 20%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 20114 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation. The DES is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the DVA but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.

Bilateral Tibial Periostitis. The CI began to seek care for bilateral shin pain beginning 2 July 2001 during basic training. Bone scan and X-rays were consistent with shin splints (tibial periostitis) without stress fracture. The CI was treated with rest followed by gradual return to activities. By the time of a clinic examination on 28 August 2001, there was no pain and the gait was normal. The CI continued to satisfactorily progress with increased activity levels. At a 9 October 2001 clinic follow up examination, the CI continued to report absence of pain and had a normal gait. A test run in physical therapy on 15 October 2001 indicated no increased pain after 1.5 miles at a 5.1 mile per hour pace. The CI was returned to full activity however she experienced recurrent activity limiting pain in the shins and right femur with a physical training test and battle stations exercise and MEB was initiated. The MEB narrative summary physical examination, 22 October 2001, noted the CI complained of bilateral shin pain and ambulated with moderate pain. She was minimally tender over both tibial bones without any signs of inflammation. There was no muscle atrophy. The examiner noted the bilateral shin splints with tibial periostitis would require a prolonged convalescence but had a good prognosis. The VA Compensation and Pension (C&P) examination was performed on 27 November 2001, less than 2 months prior to separation. At that time, the CI complained of bilateral shin pain, exacerbated by prolonged standing or walking. She had a normal posture, gait and stride. There was tenderness to palpation over both shin areas without any signs of inflammation.

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the bilateral tibial periostitis condition analogously to code 5003 (osteoarthritis) and assigned a 10% rating. The VA rated the same condition 0% under code 5022 (periostitis), citing no evidence of painful or limited motion of a major joint or group or minor joints. The Board noted that the CI became asymptomatic by the end of August and tolerated increasing activity through mid October without difficulty indicating good recovery. However she experienced recurrent pain with the first strenuous training activity. By the time of the C&P examination over a month later, the CI’s condition had again improved with cessation of military training activities. The CI reported foot pain was more bothersome than leg pain. All members agreed at the time of the C&P examination which was more proximate to the time of separation, the condition more nearly approximated the 0% rating adjudicated by the VA.

The Board therefore concluded the preponderance of evidence did not support a rating higher than that adjudicated by the PEB at the time of separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral tibial periostitis condition.

Right Femoral Stress Fracture. As reviewed above, the CI sought care for shin splints beginning 2 July 2001. Service treatment records did not document complaints of right thigh (femur pain) at this time, however imaging (bone scan and X-rays) detected a healing right femoral stress fracture. A 20 August 2001 clinic examination noted the right femur stress fracture was “asymptomatic” (without symptoms). The CI was treated with rest followed by gradual return to activities. By the time of a clinic examination on 28 August 2001, there was no leg pain and the gait was normal. The CI continued to progress satisfactorily with increased activity levels. The 26 September 2001 clinic follow up examination noted the right femoral stress fracture to be resolved. At a 9 October 2001 clinic follow up examination, the CI continued to report absence of leg pain and had a normal gait. A test run in physical therapy on 15 October 2001 indicated no increased pain after 1.5 miles at a 5.1 mile per hour pace. The CI was returned to full activity however she experienced recurrent activity limiting pain in the shins and right femur with a physical training test and battle stations exercise and MEB was initiated. The MEB physical exam performed on 22 October 2001 noted the CI was walking with moderate pain. There was right thigh pain with examination maneuvers that stressed the right femur. At the C&P exam performed a month prior to separation, the CI reported right mid-thigh pain aggravated by cold weather however she reported her feet were more painful than her legs. On examination there was deep tenderness over the right mid-thigh with no significant local weakness and no painful motion. There was a full range-of-motion for both hips and knees, without pain or weakness. The right hip had a mild lack of endurance without lack of coordination. Gait was normal. The examiner noted the right femur stress fracture would require a prolonged convalescence but had a good prognosis.

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and VA adjudicated the right femur condition analogously to code 5255 (impairment of the femur) and assigned the same 10% disability rating. The VA considered malunion of the femur with slight knee or hip disability. There was no evidence of moderate knee or hip disability, there was no nonunion or malunion of the right femoral bone to assign a greater disability rating. The Board agreed there was no evidence to support a higher rating than that adjudicated by the PEB and noted the normal gait and normal exam with expected continued recovery supported a 0% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right femoral stress fracture 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the right femoral stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Bilateral Tibial Periostitis
 5022-5003 10%
Right Femoral Stress Fracture
 5003-5255 10%
COMBINED
 20%

The following documentary evidence was considered:

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





xx
President
Physical Disability Board of Review


 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 19 Aug 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- former USMC
- former USN
- former USMC
- former USN
- former USMC
- former USN
- former USN
- former USMC
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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