RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXXX CASE: PD1201879 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130409 

SEPARATION DATE: 20020227 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PV2/E-2 (92A/Basic Trainee) medically separated for 
an ankle injury. The CI injured her ankle in a fall during basic training. Despite physical therapy 
and conservative treatment, the ankle could not be adequately rehabilitated 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 condition, characterized as medial malleolar and first metatarsal stress fractures 
was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-
501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated 
medial malleolar and first metatarsal stress fractures as unfitting rated 10% with application of 
the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was 
medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “Due to this injury, my military career was ended. I still have limited range of 
motion from injury and cannot run without pain. I have had problems with my feet since 
injury.” 

 

 

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 foot condition is 
addressed below. 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 
respective Service Board for Correction of Military Records. 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. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20011218 

VA - (2 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Medial Malleolar and 

First Metatarsal 

Stress Fractures 

5022-5003 

10% 

Residuals, Left First Metatarsal 
Stress Fracture 

5299-5283 

0% 

20020418 

Residuals, Left Medial Malleolar 
Stress Fracture 

5271 

10% 

20020418 

No Additional MEB/PEB Entries 

 

 

Combined: 10% 

Combined: 10%* 



Derived from VA Rating Decision (VARD) dated 20020620 (most proximate to date of separation). VARD of 20040514 granted 
10% rating, backdated to day after separation, combined 10%. Original decision was NSC. 

 


 

ANALYSIS SUMMARY: 

 

Left ankle condition. The CI injured her left ankle on 31 July 2001. Magnetic resonance imaging 
(MRI) was negative, but a bone scan showed increased uptake in the medial malleolus and the 
first metatarsal. She was treated with boot brace, physical therapy (PT), and rest. In spite of 
treatment, her pain persisted and a MEB was initiated. The MEB clinical evaluation was in 
November 2001, 3 months prior to separation. The CI reported left ankle pain that was worse 
with standing, walking, or running. On physical exam, she was in no acute distress and had a 
mildly antalgic gait. The left ankle had mild tenderness to palpation (TTP). There was some 
metatarso-phalangeal (MTP) joint tenderness and a slight anterior drawer. Muscle strength 
was normal. The left ankle had full range-of-motion (ROM). Pulses and sensation were normal. 
There was no swelling, redness, or warmth. As noted above, the CI was medically separated 
from the Army on 27 February 2002. 

 

The CI was seen for a follow-up visit on 15 March 2002. She reported constant pain over the 
lateral aspect of the left ankle with prolonged standing or walking (more than 15 minutes). She 
took Tylenol as needed. Exam showed a slightly antalgic gait. There was mild edema over the 
lateral ankle joint extending onto the left foot. Maximum tenderness was along the lateral 
malleolus. There was mild pain with forced dorsiflexion of the ankle joint. Active dorsiflexion 
was zero degrees. There was no pain with MTP joint range of motion (ROM). 

 

At the April 2002 VA Compensation and Pension (C&P) exam, 2 months after separation, the CI 
reported pain over the medial and lateral sides of her left ankle when she stood for more than 
an hour, or when she walked more than half a mile. There was no giving out or locking of the 
ankle. She had not worked since separation, and her symptoms had subsided considerably 
while sitting at home. On exam she had a normal gait, no limp, and no soft tissue swelling or 
redness. There was no pain or discomfort with ROM exercises. Neither palpation of the ankle 
area, nor of the MTP joint was tender or painful. Sensation and circulation were normal. ROM 
included inversion of the ankle to 15 degrees, and eversion of the ankle to 10 degrees. There 
were no positive objective findings over the foot and ankle, indicating that the stress fractures 
of the left foot had healed. The two goniometric ROM evaluations which were weighed by the 
Board in arriving at its rating recommendation are summarized below. 

 

Left Ankle ROM 

MEB ~ 3 mos. Pre-Sep 

(20011130) 

VA C&P ~ 2 mos. Post-Sep 

(20020418) 

Dorsiflexion (20° is normal) 

30° 

15° 

Plantar Flexion (45° is normal) 

60° 

25° 

§4.71a Rating 

0% 

10% 



 

The Board carefully reviewed all evidentiary information available, and directs attention to its 
rating recommendation based on the above evidence. The Army PEB combined the CI’s two 
pain problems into a single unfitting condition characterized as: “Medial malleolar and first 
metatarsal stress fractures, with a history of a fall in basic training.” The condition was coded 
5022-5003 and rated at 10%. The Board evaluated whether or not it was appropriate for the 
two problems to be “bundled” together. The Board must determine if the PEB’s approach of 
combining the conditions under a single rating was justified in lieu of separate ratings. The 
Board must apply separate codes and ratings in its recommendations if compensable ratings for 
each condition are achieved IAW the Veterans’ Administration Schedule for Rating Disabilities 
(VASRD). If the Board judges that two or more separate ratings are warranted, it must satisfy 
the requirement that each ‘unbundled’ condition was separately unfitting. After due 
deliberation, the Board agreed that the evidence did not support a conclusion that each of the 
pain conditions, separately, would have rendered the CI unable to perform her required 
military training. Accordingly, the Board does not recommend a separate disability rating for 


the two pain problems. It is appropriate for the medial malleolar stress fracture and the first 
metatarsal stress fracture to be “bundled” together, and treated as a single unfitting condition. 

 

Based on the evidence in the service treatment record (STR), the Board unanimously agreed 
that the CI’s left lower extremity pain condition was best described as “mild to moderate.” 
There was insufficient evidence to support classifying the condition as “marked” or “severe.” 
After due deliberation, the Board determined that a separation disability rating of 10% was 
warranted, due to the left lower extremity problem. The Board tried to find a path to a rating 
higher than 10%, using other codes which could be applied to the pain condition. The other 
VASRD codes that were considered did not result in a rating higher than 10%, since the STR did 
not show sufficient evidence of a significantly disabling abnormality which would justify a rating 
higher than 10%. 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 left lower extremity 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. In the matter of the 
medial malleolar and first metatarsal stress fractures, 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 

Medial malleolar and first metatarsal stress fractures 

5022-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20121014, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, 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 
xxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009563 (PD201201879) 

 

 

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)