RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX CASE NUMBER: PD1201437 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130409 

SEPARATION DATE: 20020715 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve PV2/E-2 (None), medically separated for bilateral interior 
pubic ramus stress fracture. The CI noted right hip and groin pain on 19 December 2001 during 
basic training and later developed bilateral leg pain. Despite aggressive physical therapy (PT), a 
30 day convalescent leave and Orthopedics evaluations, the CI failed to meet the physical 
requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded bilateral inferior pubic ramus stress fractures and bilateral tibial shaft and 
medial tibial plateau stress fractures conditions for Physical Evaluation Board (PEB) 
adjudication. The PEB adjudicated the bilateral inferior pubic ramus stress fractures, X-ray 
verified, with other lower extremity stress reactions on bone scan condition as unfitting, rated 
0% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI 
made no appeals, and she was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “The member still experiences pain and is unable to do various functions 
during employment. MEB proceedings DS Form 3947 Sep 93 state condition is permanent.” 

 

 

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 conditions bilateral interior pubic 
ramus stress fractures as requested for consideration meet the criteria prescribed in DoDI 
6040.44 for Board 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 IPEB – Dated 20020502 

VA (4 Mos. Post-Separation) – All Effective Date 20020716 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Inferior Pubic 
Ramus Stress Fractures, X-
Ray Verified with Other 
Lower Extremity Stress 
Reactions on Bone Scan 

5299-5010 

0% 

Stress Fracture Left Tibia 

5299-5262 

0% 

20021217 

Stress Fracture Right Tibia 

5299-5262 

0% 

20021217 

Bilateral Pelvic Stress 
Fractures 

5299-5255 

Non 
Service 
Connected 

(NSC) 

20021217 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 5 

20021217 

Combined: 0% 

Combined: 0% 



 


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which her service-incurred condition continues to 
burden her. The Board utilizes VA 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 Disability Evaluation System (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 PEB combined the bilateral inferior pubic ramus stress fractures X-ray verified with other 
lower extremity stress reactions on bone scan condition as a single unfitting condition, coded 
analogously to 5010 and rated 0%. This coding approach is countenanced by AR 635-40 (B.24 
f.), but IAW DoDI 6040.44 the Board must apply only VASRD guidance to its recommendation. 
The Board must therefore apply separate codes and ratings in its recommendations if 
compensable ratings for each joint are achieved IAW VASRD §4.71a. If the Board judges that 
two or more separate ratings are warranted in such cases, however, it must satisfy the 
requirement that each “unbundled” condition was reasonably justified as unfitting in and of 
itself. 

 

Bilateral Inferior Pubic Ramus Stress Fractures X-ray Verified with Other Lower Extremity Stress 
Reactions on Bone Scan Condition. The Board first considered whether the bilateral inferior 
ramus condition and other lower extremity stress reactions condition, having been de-coupled 
from the combined PEB adjudication, remained independently unfitting as established above. 
The CI was issued a permanent profile related to the bilateral inferior pubic ramus stress 
fractures and bilateral tibial stress reactions condition in May 2002 with restrictions of no 
running, no jumping, no marching, no squatting no push-ups and no sit-ups required for her 
MOS. All members agreed that the bilateral inferior pubic ramus stress fractures and bilateral 
tibial stress reactions, as isolated conditions, would have rendered the CI incapable of 
continued service within her MOS; and, accordingly merits separate ratings. 

 

The CI was placed on convalescent leave January–February 2002 due to right hip pain and 
bilateral leg pain. A bilateral leg X-ray of the tibia and fibula done to rule out stress fractures at 
the mid tibial shaft medially was normal. The physical therapist noted pain with running and 
walking in both inferior pubic rami and bilateral tibias. A bone scan performed in April 2002 
revealed bilateral inferior pubic rami stress fractures; early stress fracture of the medial aspect 
of the proximal right tibia, distal to the medial tibia plateau; focal stress fracture changes of 
bilateral mid tibias and multi focal severe stress reaction versus early stress fracture about 
numerous locations in the area of the bilateral ankles and mid feet. A repeat bilateral right and 
left tibia and fibula X-ray was done for lower leg pain and was negative. 

 

The CI was evaluated by PT for antalgia and bilateral hip pain during running and marching with 
pain on extension and abduction in December 2001. A pelvic X-ray found acute bilateral pubic 
rami stress fractures. A repeat pelvic X-ray showed healing pubic rami stress fractures. PT 
noted continued bilateral hip pain and tenderness. 

 

The MEB narrative summary (NARSUM) examination approximately 2 months prior to 
separation noted that although the CI was placed on a 30 day convalescent leave, she 
continued to have significant pain. The examiner noted that the CI was unable to run, jump, 
march, and perform sit-ups, push-ups, or strenuous activity without significant discomfort. The 
examiner opined that for the bilateral inferior pubic ramus stress fractures, the CI was 


moderately to severely symptomatic, and she failed to progress in spite of rest and PT and if 
she continued with her basic training or military activities, the fractures would not heal and the 
pain would continue. Regarding the bilateral tibial shaft and medial tibial plateau stress 
fractures, the examiner opined that the CI was moderately symptomatic and that she was 
unable to continue training secondary to the leg pain. The examiner further opined that in both 
cases of the bilateral pelvic stress fractures and the bilateral tibial stress fractures that they 
were expected to heal once discharged from the military. The CI was placed on a permanent L3 
profile for bilateral inferior pubic ramus stress fractures and bilateral tibial stress fractures. The 
MEB NARSUM physical exam findings are summarized in the chart above. The VA 
Compensation and Pension (C&P) examination approximately 6 months after separation 
indicated chronic leg pain and exacerbations with strenuous activity such as walking up stairs or 
walking distances. During a flare-up, the examiner further noted that the CI could not perform 
activities of daily living. 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 combined the two conditions of the bilateral inferior pubic ramus stress fractures X-ray 
verified with other lower extremity stress reactions on bone scan under 5299 analogous to 
5010 arthritis, due to trauma, substantiated by X-ray findings rated 0%. The VA coded the 
stress fracture left tibia analogous to 5262 tibia and fibula, impairment of and rated 0% and 
stress fracture right tibia analogous to 5262 tibia and fibula, impairment of and rated 0%. The 
VA coded bilateral pelvic stress fracture analogous to 5255 femur, impairment of and 
determined it was not service-connected as there was no evidence of this condition at the time 
of the C&P examination. The MEB exam indicated that a 30 day convalescent leave for the 
bilateral pelvic rami and bilateral tibial stress reactions failed to improve the CI’s symptoms and 
she still was unable to perform strenuous activity without significant pain. The examiner 
documented that if basic training or military activities continued all stress fracture areas would 
continue to endure significant pain and these activities would prevent healing. The MEB 
examination was closer to separation and was adjudged by the Board to have a higher 
probative value. After due deliberation considering all of the evidence and mindful of VASRD 
§4.3 Reasonable doubt, the Board recommends disability ratings of 0% for the right inferior 
pubic ramus stress fracture condition and 0% for the left inferior pubic ramus stress fracture 
condition. The Board deliberated on the bilateral tibial stress fractures condition. After due 
deliberation considering all of the evidence and mindful of VASRD §4.3 Reasonable doubt, the 
Board recommends disability ratings of 0% for the right tibia stress reaction condition and 0% 
for the left tibia stress reaction 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, the 
PEB bundled four separate conditions and the Board determined that the right and left inferior 
ramus stress fracture conditions and the right and left lower extremity stress reactions 
conditions, were each separately unfitting. 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 
bundled right pelvic stress fracture condition, the Board agrees that it was separately unfitting 
and unanimously recommends a disability rating of 0%. In the matter of the bundled left pelvic 
stress fracture condition, the Board unanimously agrees that it was separately unfitting and 
unanimously recommends a disability rating of 0%. In the matter of the bundled right tibia 
stress reaction condition, the Board unanimously agrees that it was separately unfitting and by 
a vote of 2:1 unanimously recommends a disability rating of 0%. The single voter for dissent 


who recommended a 10% rating coded 5299-5010 did not elect to submit a minority opinion. 
In the matter of the bundled left tibia stress reaction condition, the Board unanimously agrees 
that it was separately unfitting and by a vote of 2:1 recommends a disability rating of 0%. The 
single voter for dissent who recommended a 10% rating coded 5299-5010 did not elect to 
submit a minority opinion. As the combined rating remained 0% after unbundling the four 
conditions, the Board recommends no recharacterization of the CI’s disability and separation 
determination. 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 Inferior Pubic Ramus Stress Fractures, X-Ray Verified with 
Other Lower Extremity Stress Reactions on Bone Scan 

5299-5010 

0% 

COMBINED 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120622, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

Director of Operations 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009575 (PD201201437) 

 

 

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 xxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)