RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200939 SEPARATION DATE: 20020422 

BOARD DATE: 20130321 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard PV2/E-2 (77F/Petroleum Supply Specialist), 
medically separated for bilateral tibial stress fractures and stress fracture of right first 
metatarsal. The CI developed shin and foot pain and was evaluated during week seven of his 
basic training by orthopedics and podiatry. His stress fracture conditions did not respond to 
aggressive conservative therapy and he was unable to meet the physical requirements of his 
Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded 
bilateral tibial stress fractures and right first metatarsal stress fracture as separate conditions. 
No other conditions were forwarded for Physical Evaluation Board (PEB) adjudication. The PEB 
combined the two conditions and adjudicated them as bilateral tibial stress fractures and stress 
fracture of right first metatarsal, unfitting, rated 0% with 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: “Starting to have problems with my legs & developing some arthritis.” 

 

 

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 Army rated conditions bilateral tibial 
stress fractures and right first metatarsal stress fracture as requested (leg pain) for 
consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is 
addressed below. No other condition was requested or meets the criteria prescribed in DoDI 
6040.44. 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 PEB – Dated 20020319 

VA (VARD dated 20020423 – 5 Days Post-Separation) – All Effective 
Date 20020418 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Tibial Stress 
Fractures and Stress 
Fracture Right First 
Metatarsal 

5099-5003 

0% 

Bilateral Tibial Stress Fractures 
and Stress Fracture Right First 
Metatarsal 

5099-5010 

10% 

STR 

.No Additional MEB/PEB Entries. 

Not Service-Connected x 1 

 

Combined: 0% 

Combined: 10% 



 

 


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-incurred condition continues to 
burden him. It is a fact, however, 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. This role and authority is granted 
by Congress to the Department of Veterans Affairs (DVA). 

 

Bilateral Tibial Stress Fractures and Stress Fracture Right First Metatarsal. The PEB combined 
bilateral tibial and right first metatarsal stress fractures as the single unfitting and solely rated 
condition, coded analogously to 5003. Although this approach complies with AR 635.40 (B.24 
f.), the Board must apply separate codes and ratings in its recommendations, if compensable 
ratings for each condition 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 unfitting in and of itself. 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, not a judgment that each condition was 
independently unfitting. 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. The CI developed right foot pain in 
November 2001, confirmed by bone scan to be due to a stress fracture. Conservative 
treatment and activity modification resulted in slow improvement. The final podiatry note on 
23 January 2002 assessed the condition as "healing." By this time however, the CI was also 
complaining of left knee pain with prolonged standing only which progressed over the next 2 
weeks to bilateral knee pain. A repeat bone scan on 4 February 2002 suggested early stress 
fractures of both tibial plateaus. The narrative summary (NARSUM) on 28 February 2002 (2 
months prior to separation) notes a history of bilateral knee pain, without locking, popping, 
giving way, or effusions. The exam of the knees noted tenderness at the medial tibial condyles 
extending to the medial tibial shafts. The exam was silent regarding foot tenderness. There 
were no findings of edema, inflammation, bruising, or effusion. There were no neurologic or 
vascular deficits in the distal legs or feet. The examiner noted “full active range of motion 
without pain.” The NARSUM cited X-rays of the left knee in January 2002 which showed a 
possible stress fracture in the condylar region of the distal left femur. A permanent profile 
dated 4 March 2002 stated: "Bilateral tibial stress fractures. Status post right 1st metatarsal 
stress fracture." The VA relied on Service treatment records in lieu of a VA Compensation and 
Pension (C&P) exam. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB’s 0% rating was based on an analogous 5003 code (degenerative arthritis) IAW USAPDA 
pain policy, while the VA assigned a 10% rating under an analogous 5010 code (traumatic 
arthritis). The Board first considered if the right first metatarsal stress fracture condition, 
having been de-coupled from the combined PEB adjudication, remained independently 
unfitting as established above. In analyzing the intrinsic impairment for appropriately coding 
and rating the right first metatarsal fracture condition, the Board is left with a questionable 
basis for arguing that it was indeed independently unfitting. The last podiatry note in evidence 
indicated the stress fracture was healing. Subsequent clinical notes focused exclusively on the 
tibia conditions, while the NARSUM examiner did not indicate foot symptoms were an ongoing 
issue. Finally, the language of the permanent profile (i.e. "status post") implied that the 
condition had passed. After due deliberation, the Board agreed that evidence does not support 
a conclusion that right first metatarsal stress fracture, as an isolated condition, would have 
rendered the CI incapable of continued service within his MOS; and, accordingly cannot 
recommend a separate rating for it. Next, the Board carefully considered the option of rating 
both tibial stress fractures together, noting that the VA also adopted this approach. A bilateral 
rating of 10%, coded 5099-5003, is a good analogy to both the pathology and disability. Since 
rating analogously defaults to 5003 rating criteria, without regard to confirmed radiographic 


findings, a 10% rating for two major joints is supported. After due deliberation, considering all 
of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 
disability rating of 10% for the bilateral tibial stress fracture condition, coded 5099-5003. 

 

 

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 5099-5003 was operant in this case and the 
condition was adjudicated independently of that policy by the Board. In the matter of the 
bilateral tibial stress fractures condition, the Board unanimously recommends a disability rating 
of 10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the right first metatarsal stress 
fracture condition, the Board unanimously agrees that it cannot recommend a finding of unfit 
for additional 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 

Bilateral Tibial Stress Fractures 

5099-5003 

10% 

Stress Fracture Right First Metatarsal 

Not Unfitting 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120603, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxxxx, AR20130008770 (PD201200939) 

 

 

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 10% 
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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)