RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201222 SEPARATION DATE: 20020621 

BOARD DATE: 20130313 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PV2/E-2 (19K/Armor Crewman), medically separated 
for multiple stress fractures of the bilateral lower extremities. Within months of entering the 
service the CI had complaints of ankle pain and multiple stress fractures were suspected and 
confirmed by bone scan. The bilateral knee and ankle pain could not be adequately 
rehabilitated in order 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 no other conditions for Physical 
Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic knee and ankle pain due 
to multiple stress fractures as a single unfitting condition, 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: “Legs still constantly hurting, still get stress fractures also shin splints, also 
knee problems (pain and swelling).” 

 

 

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 20020517 

VA (STR Used) – All Effective Date 20020622 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Knee and Ankle 
Pain / Multiple Stress 
Fractures 

5099-5003 

0% 

Multiple Stress Fractures of 
Bilateral Lower Extremities 

5299-5010 

10% 

STR 

.No Additional MEB/PEB Entries. 

0% X 0 / Not Service-Connected x 0 

 

Rating: 0% 

Rating: 10% 



*Effective 30 June 2006, the VA rated each lower extremity at 10% for a combined 20% rating. 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-aggravated 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). The DVA, operating under a different 
set of laws (Title 38, United States Code), is empowered to compensate 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 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. 

 

Multiple Stress Fractures of the Bilateral Extremities. The PEB combined bilateral knee and 
ankle pain as the single unfitting and solely rated condition, coded analogously to 5003. 
Although this approach complies with AR 635.40 (B.24 f.), this approach by the PEB, not 
uncommonly, 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. First, the Board must satisfy the requirement that each unbundled 
condition was unfitting in and of itself and apply separate codes and ratings in its 
recommendations if each condition is separately 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. Soon after 
beginning basic training, the CI complained of bilateral lower extremity pain. A bone scan in 
March 2002 noted the presence of stress fractures of the bilateral tibial plateaus and diaphyses. 
At an outpatient evaluation on 8 April 2002 the CI reported that shin pain had resolved, but 
that the knees and the left ankle were worsening despite adhering to an activity limiting profile. 
Examination noted a normal gait. The narrative summary (NARSUM) evaluation on 29 April 
2002 (2 months prior to separation) reported bilateral knee and ankle pain that worsened with 
walking. Anti-inflammatory medication was not helpful for pain. Examination revealed knee 
range-of-motion (ROM) of 0-140 degrees bilaterally (normal 0-140 degrees) and tenderness 
over the medial tibial plateaus and left medial distal tibia. There was no redness or swelling. 
Ankles showed full active ROM with tenderness below the medial malleolus. Ankle swelling 
and redness was absent. A follow-up bone scan on 7 August 2003 (13 months after separation) 
showed resolution of the previously identified stress fracture abnormalities. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB’s DA Form 199 reflected application of the VASRD analogous 5003 code for rating bilateral 
knee and ankle pain together at 0%. The VA, based on the service treatment record (STR), also 
assigned a single rating for the bilateral condition, at 10%, under an analogous 5010 code. 
Board members agreed that clinical and radiographic evidence did not support the inclusion of 
ankle pain as unfitting, separate from the tibial plateau/diaphyseal stress fractures; but also 
agreed that it would be overly speculative to conclude that either lower extremity was not itself 
independently unfitting. The Board considered that there was no compensable limitation of 
motion and no radiographic evidence of degenerative changes, but debated whether a normal 
gait, generally unremarkable physical examination findings and subsequent resolution of 
radiographic evidence of stress fractures depicted a sufficiently severe objective functional 
impairment to warrant application of §4.40 or §4.59. The Board also carefully considered the 
option of rating both lower extremities together, noting that the VA declined to rate each 
extremity separately. 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 (Resolution of 
reasonable doubt), the Board recommends a disability rating of 10% for the bilateral lower 
extremity 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 chronic knee and ankle pain was operant in this 
case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the chronic knee and ankle pain condition, the Board unanimously recommends a 
disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. 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 

Chronic Knee and Ankle Pain Due to Multiple Stress Fractures 

5099-5003 

10% 

RATING 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120611, 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 / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130007857 (PD201201222) 

 

 

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 xxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)