RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200191 SEPARATION DATE: 20051026 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SSG/E6 (91W/Health Care Specialist) medically 
separated for osteopetrosis (cervical spine, lumbar spine, shoulder, hip, knee and ankle joints). 
A year prior to separation, the CI was found to have osteopetrosis during an evaluation for right 
hip pain from running. Due to the progressive nature of the disease, it was determined that he 
would not regain sufficient function to return to full unlimited duty in the foreseeable future 
and meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy 
physical fitness standards. He was issued a permanent P3L3 profile and referred to a Medical 
Evaluation Board (MEB) which forwarded osteopetrosis to the Informal Physical Evaluation 
Board (IPEB) as an unfitting condition. The MEB forwarded no other conditions to the IPEB. 
The IPEB adjudicated osteopetrosis involving the cervical spine, osteopetrosis involving the 
lumbar spine, and osteopetrosis involving shoulder, hip, knee and ankle joints as unfitting, 
rated 10%, 10%, and 0% respectively, with application of the Veterans Affairs Schedule for 
Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB); however, the records do 
not indicate an FPEB was accomplished. The US Army Physical Disability Agency (USAPDA) did 
issue an administrative correction (dated 7 Sept 2005) to the IPEB DA Form 199. This only 
corrected the disability description and made no change to the IPEB ratings. The CI was then 
medically separated with a 20% combined disability rating. 

 

 

CI CONTENTION: “Prior to being medically separated from the Army with a 20% rating a 
rebuttal was filed to the PEB but no changes were made. A formal request for continuance on 
active duty was made but was denied. A rating of 20% for osteopetrosis was assigned before 
the debilitating effects on my health were fully discovered. Less than one year later the Dept of 
Veteran Affairs (VA) issued a rating of 90% for various conditions caused by 
osteopetrosis/hypophosphatemic rickets. The Physical training and rigors of deployments to 
Kuwait and Iraq further exacerbated my serious medical condition. Conditions of headaches, 
kyphoscolisis with spinal compression fractures, left hip strain, right hip strain, left shoulder 
strain, right shoulder strain, hyperparathyroidism, hypertension, left and right knee strain and 
left and right ankle strain were not considered at the time of separation but were rated by the 
VA. X-ray and CT scans also revealed micro-fractures in multiple areas of my body that were 
not considered at the time of separation.” 

 

 

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 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 ratings 
for unfitting conditions will be reviewed in all cases. The osteopetrosis (neck, back, shoulder, 
hip, knee and ankle) condition, as requested for consideration, meets the criteria prescribed in 
DoDI 6040.44 for Board purview and is addressed below. The remaining conditions rated by 
the VA at separation and listed on the DA Form 294 are not within the Board’s purview. 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 Army Board for 
Correction of Military Records. 

RATING COMPARISON: 

 

Service PDA Admin Corr – Dated 20050907 

VA (10 Mos. Post-Separation) – All Effective Date 20051027 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Osteopetrosis C spine 

5299-5240 

10% 

NO VA ENTRY 

Osteopetrosis L spine 

5299-5240 

10% 

Osteopetrosis w/increased bone 
density of pelvis, femurs, tibias, 
fibulas and Lumbosacral spine 

5003-5013 

20% 

Uncertain 

Osteopetrosis shoulder, 
hip, knee and ankle joints 

5099-5016 

0% 

NO VA ENTRY 

.No Additional MEB/PEB Entries. 

R shoulder strain 

5299-5203 

10% 

20060829 

L shoulder strain 

5299-5203 

10% 

20060829 

R Hip strain 

5299-5203 

10% 

20060829 

L Hip strain 

5299-5252 

10% 

20060829 

Residuals L knee strain 
w/osteoarthritis 

5299-5260 

10% 

20060415 

Residuals R knee strain 
w/osteoarthritis 

5262 

10% 

20060415 

Residuals L ankle strain 

5271 

10% 

20060415 

Residuals R ankle strain 

5271 

10% 

20060415 

Lumbar Strain…… 

5299-5235 

20% 

20060829 

Headaches 

8199-8100 

30% 

20060829 

Hypertension 

7101 

10% 

20060829 

Hyperparathyroidism 

7904 

10% 

20060829 

0% X 1 / Not Service-Connected x 2 

 

Combined: 20% 

Combined: 90% 



*CI rated 0% for B ankle and B knees when he left the USMC in June 2001. 

 

 

ANALYSIS SUMMARY: The Disability Evaluation System (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 Department of Veterans Affairs (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 VASRD standards, based on severity at the time of 
separation. The Board utilizes DVA evidence proximal to separation in arriving at its 
recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to 
post-separation evidence. The Board’s authority as defined in DoDI 6044.40, however, resides 
in evaluating the fairness of DES fitness determinations and rating decisions for disability at the 
time of separation. Post-separation evidence, therefore, is probative only to the extent that it 
reasonably reflects the disability and fitness implications at the time of separation. The Board 
has neither the jurisdiction nor authority to scrutinize or render opinions in reference to the CI’s 
statements in the application regarding suspected DES improprieties in the processing of his 
case. 


 

In October 2004, the CI presented with a several week history of right hip pain. This persisted 
despite rest and medications. On 12 October 2004, an X-ray showed increased density of the 
bones. X-rays of the skull, spine, arms and legs were significant for increased density of the 
upper skull, which might have been a normal variant, and lumbosacral spine. A bone scan was 
remarkable for generalized increased uptake. Further radiographic studies and laboratory 
testing led to the diagnosis of adult Type II osteopetrosis with mild secondary 
hyperparathyroidism. This is an inherited condition with variable expression in adulthood. It 
was determined to be an existed prior to service (EPTS) condition, but with compensable 
disabilities IAW 10 USC 1207a. The CI was issued a P3L3 profile and referred to the MEB. The 
commander noted that he was incapable of lifting heavy boxes and parts for vehicles, repetitive 
bending, as well as performing vehicle maintenance and that he was incapable of performing 
his MOS duties in a combat environment. At the MEB examination on 3 May 2005, the CI 
reported that “he was currently unable to run secondary to unbearable pain in his hips and pain 
when he wears his load bearing vest, aid pack or rucksack.” The examiner noted that “…his 
disease is progressive and will result in impaired orthopedic functioning as it already has, this 
soldier will not regain sufficient function to return to full unlimited duty anytime in the foreseen 
future, if at all.” He was referred to the MEB IAW AR 40-501 Chapter 3-41 e(1) “Miscellaneous 
conditions and defects. Conditions and defects not mentioned elsewhere in this chapter are 
causes for referral to an MEB, if— (1) The conditions (individually or in combination) result in 
interference with satisfactory performance of duty as substantiated by the individual’s 
commander or supervisor.” The Board noted that the CI requested continuation of active duty 
implying that he thought that his conditions did not render him unfit for continued service. The 
Board also observed that the CI scored a 284 on his Army Physical Fitness Test (APFT) test in 
April 2004, 18 months prior to separation, and that his rater commented that he “maximized 
every PT session to improve the squad’s overall fitness, soldier has the highest APFT score in 
the company.” 

 

Osteopetrosis Condition of the cervical spine. There were no visits in the record for cervical 
spine complaints. X-rays were normal. There was one goniometric range-of-motion (ROM) 
evaluation in evidence which the Board weighed in arriving at its rating recommendation. At 
the 13 July 2005 physical therapy appointment for ROM measurements, 3 months prior to 
separation, the CI was noted to exceed VA normal criteria for flexion and extension, but to have 
reduced lateral flexion (bending) and rotation with a combined ROM of 280 degrees with a VA 
normal of 340 degrees, all due to pain. The neck condition was not separately addressed in 
either the MEB narrative summary (NARSUM) or the VA Compensation and Pension (C&P) 
examinations. The Board opined that the evidence does not support a finding of “unfit” for the 
neck condition. However, it is not within the scope of the Board to change a condition, which 
has been found “unfitting” by the PEB, to “not unfitting.” The PEB rated the disability at 10%, 
coded 5299-5240, analogous to ankylosing spondylitis, citing the reduced combined ROM. The 
VA did not rate the cervical spine. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was 
insufficient cause to recommend a change in the PEB adjudication for the neck condition. 

 

Osteopetrosis Condition of the lumbosacral spine. There were two goniometric ROM 
evaluations in evidence, with documentation of additional ratable criteria, which the Board 
weighed in arriving at its rating recommendation. 

 

Thoracolumbar ROM 

Degrees 

MEB ~3 Mo. Pre-Sep 

 

VA C&P ~10 Mo. Post-Sep 

 

Flexion (90 Normal) 

75 

50 




Combined (240) 

195 

150 

Comment 

Limited by pain 

+ Tenderness; painful motion 

§4.71a Rating 

10% 

20% 



 

The CI was initially seen for low back pain (LBP) in 2000 after weight lifting. There were no 
further entries in the records regarding LBP until a 19 November 2004 entry which noted recent 
LBP. X-rays the previous month during an evaluation for right groin pain had been suspicious 
for increased bone density of the lumbar spine. A vertebral fracture assessment scan on 
23 February 2005 showed moderate compression of L1. A letter from an endocrinologist dated 
29 March 2005 documented “some spinal compression fractures.” There were no other 
records specific for LBP in the records. The NARSUM, dictated 3 May 2005, 5 months prior to 
separation, recorded that the CI could not run due to pain in his hips and that he had pain (not 
specified) when he wore his load bearing vest, aid pack or rucksack. The ROM was slightly 
reduced in all planes. The commander’s letter noted that he could not lift heavy boxes nor 
bend repetitively. A C&P examination on 15 April 2006, 6 months after separation, for the 
ankles and knees noted that the CI had most of his pain in the knees and ankles, but that the 
hips and back were also involved. At another C&P examination on 29 August 2006, 10 months 
after separation, the CI reported that he had daily LBP for which he took a narcotic. It was 
aggravated by prolonged standing and sitting. No assistive devices were in use. Gait was 
documented as steady on a separate examination for the joints that same day. He was noted 
to have paraspinal tenderness and kyphosis. The ROM, above, was guarded. Although his 
symptoms increased on repetitive motion, there was no further reduction in ROM. There was 
no muscle atrophy. Testing for radicular irritation was negative. X-rays were normal. The PEB 
rated the disability at 10%, coded 5299-5240, analogous to ankylosing spondylitis, citing the 
reduced combined ROM. The VA rated the lumbar spine at 20% and coded it 5299-5235, 
analogous to a vertebral fracture, utilizing the C&P ROM. The Board considered the two 
examinations. It noted that there had been no visits for LBP for almost a year prior to 
separation other than visits which were part of the evaluation for the osteopetrosis. The Board 
determined that the MEB examination and ROM better fit the condition of the CI at the time of 
separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(Resolution of reasonable doubt), the Board concluded that there was insufficient cause to 
recommend a change in the PEB adjudication for the back condition. 

 

Osteopetrosis Condition of the shoulder, hips, knees and ankles. The PEB combined 
osteopetrosis of the shoulder, hip, knee and ankle as a single unfitting condition, coded 
analogously to 5016 and rated 0%. The PEB may have relied on AR 635.40 (B.24 f.) and, or the 
USAPDA pain policy for not applying separately compensable VASRD codes. Not uncommonly 
this approach by the PEB reflects its judgment that the constellation of conditions was unfitting 
and that there was no need for separate fitness adjudications rather than a judgment that each 
condition was independently unfitting. The Board must first determine if each unbundled 
condition was unfitting in and of itself. If a condition is determined to be separately unfitting, 
the Board then applies separate codes and ratings in its recommendation IAW VASRD §4.71a. 
Thus, the Board must exercise the prerogative of separate fitness recommendations in this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB. 

 

Shoulder condition. The Board first considered if the shoulders were separately unfitting. The 
CI was seen for left shoulder pain on 23 July 2004, over a year prior to separation, and thought 
to have bicipital tendonitis for which he was treated conservatively with rest and medications. 
There are no other entries found for the shoulders in the treatment record. The commander’s 
letter noted difficulty lifting heavy boxes, but did not assign this to a particular joint. The profile 


was U1. There were no X-rays taken while on active duty, but a whole body nuclear medicine 
scan showed generalized increased uptake including the shoulders. X-rays taken by the VA 10 
months after separation were normal. The NARSUM is silent for shoulder complaints. After 
due deliberation, in consideration of the preponderance of the evidence, the Board concluded 
that this condition was not separately unfitting for either shoulder. 

 

Hip condition. The Board considered if the hips were separately unfitting. The CI presented on 
4 October 2004 with the complaint of right thigh and groin pain for 2 weeks since the CI “pulled 
something during sprints.” The pain was thought to be secondary to a strain of the hip flexors 
rather than attributed to the joint. The pain persisted leading to X-rays on 12 October 2004 
which showed increased density of the pubic bones and lumbar spine. The hips were normal, 
though. The bone scan showed diffuse, increased uptake, consistent with the systemic 
osteopetrosis, but did not show an increase localized to the hips. At the NARSUM on 3 May 
2004, the CI reported that he was unable to run secondary to “unbearable pain in his hips…,” 
but did not further address the hips. Neither the profile nor the commander’s letter 
apportioned the duty limitations between the lower back, hips, knees and ankles. The ROM 
recorded by physical therapy 3 months prior to separation was limited by pain, but nearly 
normal. Gait was not recorded on the NARSUM, but was noted to be steady on the C&P 
examinations which also noted that no assistive devices were in use. After due deliberation in 
consideration of the preponderance of the evidence, the Board concluded that this condition 
was not separately unfitting for either hip. 

 

Knee condition. The Board considered if the knees were separately unfitting. The CI was 
initially seen for right knee pain in 1999 during his first enlistment, in the USMC. He was 
diagnosed with patella-femoral pain syndrome (PFPS) and treated with medications and 
physical therapy during this enlistment. He separated from the USMC on 30 June 2001 and was 
granted service-connection for left and right knee strain by the VA. He enlisted in the Army on 
2 October 2001 and was seen on 18 October 2001 noting bilateral knee pain after running for 
three weeks. He was again treated with medications and duty limitations with apparent 
resolution. On 1 March 2004, he reported a history of bilateral knee pain for over two years 
related to activity. Bilateral magnetic resonance imaging (MRI) with contrast performed on 
2 March 2004. These showed intact ligaments, menisci and articular cartilage. The left knee 
did show evidence of a quadriceps tendinosis at the insertion into the patella. The CI was 
treated with physical therapy without significant benefit, but declined a profile. The last 
treatment note for the knees in the record was for physical therapy and dated 14 June 2004, 16 
months prior to separation. The NARSUM did not specifically address the knees, only noting 
the hip pain with running and pain from load bearing which was not specified. Again, the knees 
were not specifically profiled nor did the commander specifically address the knees. The ROM 
measured by the physical therapist was not noted as being abnormal, although both were ten 
degrees less than the VA normal values. No X-rays were obtained prior to separation. The C&P 
examination 6 months after separation noted normal ROM with some crepitus, but no 
instability. Asymmetric joint space narrowing was noted on X-rays. As already noted, the gait 
was steady and no assistive devices were in use on the post-separation VA examination 10 
months after separation. The Board noted that the knee pain had been present for over 4 years 
at the time of entry into the DES process, existed prior to his enlistment into the Army and that 
the CI had declined a profile limiting duty. After due deliberation in consideration of the 
preponderance of the evidence, the Board concluded that this condition was not separately 
unfitting for either knee. 

 

Ankle condition. The CI was seen one time for his ankles, at age 21, while still in the USMC. He 
was service-connected by the VA for each ankle after separation. There is no record in 


evidence that he sought treatment for his ankles while in the Army. Neither the commander 
nor the profile specifically addressed the ankles. The NARSUM is silent for the ankles other 
than noting a past history of plantar fasciitis. The ROM obtained by the physical therapist 3 
months prior to separation showed slightly, but symmetrically reduced dorsiflexion in the 
ankles and symmetrically increased plantar flexion. Post-separation imaging obtained by the 
VA was normal. After due deliberation in consideration of the preponderance of the evidence, 
the Board concluded that this condition was not separately unfitting for either ankle. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable doubt), the Board concluded that there was insufficient cause to recommend a 
change in the PEB adjudication for the bundled shoulder, hip, knee and ankle conditions. 

 

 

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, although it is not clear from the record what policy was used by the PEB for 
rating the bundled condition. In the matter of the neck, back, and bundled shoulder, hip, knee 
and ankle conditions 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 

Osteopetrosis Involving the Cervical Spine 

5299-5240 

10% 

Osteopetrosis Involving the Lumbar Spine 

5299-5240 

10% 

Osteopetrosis Involving the Shoulder, Hip, Knee and Ankle Joints 

5099-5016 

0% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120215, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20130005526 (PD201200191) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl XXXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)