RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200728 SEPARATION DATE: 20020123 

BOARD DATE: 20130319 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PV2/E-2 (77F/projected, but not earned), medically 
separated for “bilateral lower extremity pain secondary to stress fractures to include bilateral 
femor, right foot and left tibia.” In the third week of training, the CI developed left lower 
extremity pain attributed to running and other lower body activities required in basic training. 
Evaluations noted a right foot stress fracture and a left tibial stress fracture with bilateral 
femoral stress reactions. The left lower leg pain did not respond adequately to conservative 
treatment to meet the physical requirements of his projected Military Occupational Specialty or 
satisfy physical fitness standards. He was issued a permanent L3 profile for bilateral lower leg 
stress fractures and referred for a Medical Evaluation Board (MEB). The MEB forwarded 1) 
right foot stress fracture and 2) Left tibial stress fracture with bilateral femoral stress reactions 
as the only conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated 
the right foot stress fracture and the left tibial stress fracture with bilateral femoral stress 
reactions as a single unfitting condition, rated 0%, with cited application of the US Army 
Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically 
separated with a 0% disability rating. 

 

 

CI CONTENTION: “I received 30% disability rating from the VA back in 2003 then lost benefits 
for a no show.” The CI elaborated no specific contention in his application. 

 

 

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. 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 20011226 

VA (STR Used) – All Effective Date 20020124 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

BLE Pain secondary to 
stress fractures 

5099-5003 

0% 

RLE Stress Fracture 

5299-5014 

10% 

STR 

LLE Stress Fracture 

5299-5014 

10% 

STR 

R Foot Stress Fracture 

5299-5014 

10% 

STR 

.No Additional MEB/PEB Entries. 

0% X 0 / Not Service-Connected x 0 

 

Combined: 0% 

Combined: 30%* 



*VA proposed a reduction in ratings due to a C&P no show and then did reduce all ratings to 0% effective December 1, 2006. 

 

 

ANALYSIS SUMMARY: The PEB disability description was: “Bilateral lower extremity pain 
secondary to stress fractures to include bilateral femor, right foot and left tibia. Rated as 
minimal, occasional.” 


Right Foot Stress Fracture and Left Tibial Stress Fracture with Bilateral Femoral Stress Reactions. 
The narrative summary (NARSUM) dated 30 October 2001 indicated the CI was a trainee in 
week three of training who presented with a chief complaint 6 November 2001 of left lower 
extremity pain. The CI had been initially evaluated by the Troop Medical Clinic, and failed to 
respond to conservative treatment. The examiner stated “This occurred as a result of running 
and other lower body activities required in basic training” and the CI was not taking any 
medications. The MEB physical exam noted diffuse tenderness to palpation over the left tibial 
shaft and femoral condyle with no palpable or visible deformity. There was full active range-of-
motion (ROM) of the joints above and below the tibia with no neurovascular deficits. The 
examiner noted tenderness to palpation at the right navicular bone (foot) and stated “He has 
normal motor function throughout the lower extremity bilaterally.” Plain radiographs were 
normal on 19 November 2001. Bone scan from 27 November 2001 “revealed stress reaction of 
the bilateral tibia. There is also a stress fracture noted in the dorsum of the right foot. There is 
also focal uptake in the bilateral medial femoral condyles which is consistent with significant 
stress reaction. IMPRESSION: 1. Right foot stress fracture; 2. Left tibial stress fracture with 
bilateral femoral stress reactions.” The L3 profile listed “bilateral lower leg stress fractures.” 
The commander’s statement indicated complaints of leg pains, noted “stress fractures in both 
lower legs” without improvement following being “sent to the Fitness Training Unit to undergo 
Reconditioning for his injury.” 

 

Clinic evaluation on 27 November 2001 was a follow-up from the bone scan (not finalized) and 
the CI was on acetaminophen (Tylenol). Exam indicated “decreased” left leg extension with 
tenderness to palpation over the distal third of the tibia with edema and vibratory sensation 
change. Diagnosis was left tibial stress fracture. Clinical exam the following day indicated chief 
complaint of left tibial pain and bone scan results of “stress reaction tibial, stress fracture of 
dorsal right foot bone, and right distal femur abnormality at condyle medially.” Exam 
documented 1+ edema with tenderness to palpation of the left tibial midshaft. Orthopedic 
clinic consult had findings and diagnoses essentially similar to the typed NARSUM. The DD 
Form 2808 exam dated 10 December 2001 documented an antalgic gait, walking with crutches 
and tenderness to palpation to bilateral lower extremities. There was no VA Compensation and 
Pension (C&P) exam and the VA rating was based on service treatment records. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the right foot stress fracture, the left tibial stress fracture, and left and right 
femoral stress reaction conditions under a single disability rating, coded analogously to 5003. 
Although the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a permits combined 
ratings of two or more joints under 5003, it allows separate ratings for separately compensable 
joints. IAW DoDI 6040.44 the Board must follow suit if the PEB combined adjudication is not 
compliant with the latter stipulation, provided that each unbundled condition can be 
reasonably justified as separately unfitting in order to remain eligible for service rating. If the 
members judge that separately ratable conditions are justified by performance based fitness 
criteria and indicated IAW VASRD §4.7 (Higher of Two Evaluations), separate ratings are 
recommended; with the stipulation that the result may not be lower than the overall combined 
rating from the PEB. The Board also considered the provisions of VASRD §4.14 Avoidance of 
Pyramiding. The Board’s initial charge in this case was therefore directed at determining if the 
PEB’s combined adjudication was justified in lieu of separate findings of unfit and separate 
ratings. There was no physician diagnosis or imaging evidence of stress fractures of the right 
tibia, left femoral condyle or right femoral condyle and these areas were documented as stress 
reactions (versus stress fractures of the left tibia and right foot). 

 

The Board first considered if the left lower extremity stress fracture condition, having been de-
coupled from the combined PEB adjudication, remained reasonably justified as unfitting. The 
record demonstrated that the left lower extremity was always the chief complaint and focus of 
exams and medical record discussion supporting conclusion of unfitting. Members agreed that 


the functional limitations in evidence justified the conclusion that the left lower extremity 
stress fracture condition was integral to the CI’s inability to perform; and, accordingly a 
separate rating is recommended. There was sufficient evidence of painful motion of the left 
lower extremity to warrant a 10% rating IAW VASRD §4.59 (Painful Motion) and §4.40 
(Functional Loss) analogous to osteomalacia (5299-5014) or degenerative arthritis (5099-5003) 
slight tibia and fibula impairment (5099-5262). 

 

The Board next considered if the left femoral stress reaction having been de-coupled from the 
combined PEB adjudication, remained itself unfitting as established above. The Board 
considered that there was no separating this condition from the symptoms and disability of the 
unfitting left lower extremity stress fracture condition and any disability was appropriately 
considered under that condition and rating. After due deliberation, the members agreed that 
the evidence does not support a conclusion that the left femoral stress reaction condition was 
separately unfitting and cannot recommend a separate rating for it. 

 

The Board next considered if the right foot stress fracture condition, having been de-coupled 
from the combined PEB adjudication, remained reasonably justified as unfitting. Despite the 
record indicating that the left lower extremity was always the chief complaint, the 
commander’s statement and profile indicated bilateral lower extremity duty-impacting 
conditions, while clinical exams focused on the left leg pain. Members agreed that the 
functional limitations in evidence justified the conclusion that the right foot stress fracture 
condition was reasonably unfitting and accordingly a separate rating is recommended. There 
was sufficient evidence of painful motion of the right foot and lower extremity to warrant a 
10% rating IAW VASRD §4.59 (Painful Motion) and §4.40 (Functional Loss) analogous to 
osteomalacia (5299-5014) or degenerative arthritis (5099-5003) or Tibia and fibula impairment 
(5099-5262). After due deliberation, members agreed that the bilateral leg condition, IAW 
VASRD §4.71a rating criteria and accepted principles for fitness determination, warrants a 
recommendation for separate right and left disability ratings of 10% coded 5099-5262 to 
encompass each lower extremities disability. 

 

The Board next considered if the right femoral stress reaction having been de-coupled from the 
combined PEB adjudication, remained itself unfitting as established above. The Board 
considered that there was no separating this condition from the symptoms and disability of the 
unfitting right foot stress fracture condition and any disability was appropriately considered 
under that condition and rating. After due deliberation, the members agreed that the evidence 
does not support a conclusion that the right femoral stress reaction condition was separately 
unfitting and cannot recommend a separate rating for it. 

 

 

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, PEB 
reliance on the USAPDA pain policy for rating the CI’s lower extremity conditions was operant in 
this case and those conditions were adjudicated independently of that policy by the Board. In 
the matter of the combined bilateral lower extremity pain secondary to stress fractures to 
include bilateral femor, right foot and left tibia condition(s), the Board unanimously 
recommends that it be rated for two separate unfitting conditions as follows: left lower 
extremity pain and tibial stress fracture coded 5099-5262 with a disability rating of 10%, and 
right lower extremity pain and foot stress fracture coded 5099-5262 with a disability rating of 
10% both IAW VASRD §4.71a; and the left and right femoral stress reaction conditions 
determined to be not unfitting and thereby not subject to disability rating. 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 his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Left Lower Extremity Pain and Tibial Stress Fracture 

5099-5262 

10% 

Right Lower Extremity Pain and Foot Stress Fracture 

5099-5262 

10% 

COMBINED (w/ BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120605, 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 / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxx, AR20130006869 (PD201200728) 

 

 

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 20% 
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 xxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)