RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX CASE NUMBER: PD1201532 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130326 

SEPARATION DATE: 20021202 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard PVT/E-1 (62E/Heavy Equipment Operator), 
medically separated for bilateral tibial plateau stress fractures. The CI developed pain in his 
lower extremities between his third and fourth weeks of initial training in 2002. Despite 
convalescent leave, activity limitations, and physical therapy (PT), the CI failed to meet the 
requirements of his Military Occupational Specialty (MOS) or physical fitness standards. He was 
issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB 
forwarded “Bilateral Medial Tibial Plateau Stress Fractures,” to the Physical Evaluation Board 
(PEB) as medically unacceptable IAW AR 40-501. No other conditions were submitted by the 
MEB. The Physical Evaluation Board (PEB) adjudicated the“Bilateral Tibial Plateau Stress 
Fractures Sustained in Basic Training, unable to Complete Training” as unfitting, rated 0%, with 
application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no 
appeals and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “He still has or is having trouble with his legs and knees also, he has RLS; 
restless leg syndrome.” In block 14 (continuation of Item 5, VA Rating Information), the 
application states “Bipolar: suicidal/homcidle [sic]/shin splints schlerotic [sic]/ activity in his hip: 
R.L.S. He never filed on his feet. He caught something while in Boot Camp, his toenails most of 
them come completely off. If he known he had caught something in the shower he would’ve 
filed for it at [the] time.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those conditions 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 rating for the unfitting bilateral medial tibial plateau stress 
fractures/shin splints is addressed below. The additional conditions listed in Block 14 of the 
application (knees, bipolar, suicidal, homicidal, sclerotic activity in hip, RLS, and infection of the 
feet) were not identified by the MEB or PEB and are therefore outside the purview of this 
Board. 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 Board for 
Correction of Military Records. 

 

 

 


RATING COMPARISON: 

 

Service PEB – Dated 20020916 

VA (5 Mo. Post-Separation) – Effective 20021003 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral tibial plateau 
stress fractures 

5099-5003 

0% 

Patellofemoral pain syndrome 
right knee 

5010-5260 

10% 

20030301 

.No Additional MEB/PEB Entries. 

Patellofemoral pain syndrome 
left knee 

5010-5260 

10% 

20030301 

Combined: 0% 

Combined: 20% 



VARD 20100825 Clear and unmistakable error therefore Right Hip Synovitis increased to 10% (Combined 30%) 

 

 

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). The Board’s authority as defined in 
DoDI 6040.44, resides in evaluating the fairness of DES fitness determinations and rating 
decisions for disability at the time of separation. The Board utilizes service and DVA evidence 
proximal to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-
month interval for special consideration of post-separation evidence. Post-separation evidence 
is probative only to the extent that it reasonably reflects the disability and fitness implications 
at the time of separation. 

 

The PEB rated bilateral tibial plateau stress fractures under the single analogous code 5099-
5003 arthritis, degenerative (hypertrophic or osteoarthritis) code. 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. Since §4.71a criteria are met for separate joint ratings for the right and 
left tibia plateau stress fracture in this case, the Board is pursuing separate rating and fitness 
evaluations as follow. 

 

Bilateral Tibial Plateau Stress Fractures Condition. The Board first considered if the bilateral 
tibial plateau stress fractures, having been de-coupled from the combined PEB adjudication, 
each remained independently unfitting as established above. The CI was on a permanent 
profile with significant limitations that would have resulted from either condition alone. The 
MEB examiner documented that given the CI’s age and rapid onset of symptoms that he would 
not be able to return to full training status. All members agreed that the right and left tibia 
plateau stress fracture, as isolated conditions, would have each rendered the CI incapable of 
continued service within his training for his MOS and accordingly merits separate ratings. 

 

There were range-of-motion (ROM) evaluations in evidence, with documentation of additional 
ratable criteria, which the Board weighed in arriving at its rating recommendation; as 
summarized in the chart below. 

 

 


Knee ROM 

(In degrees) 

MEB ~2 Mo. Pre-Sep 

VA C&P ~5 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

Normal ROM 

140 

140 

Extension (0 Normal) 

0 

0 

Comment 

Lower extremities: strength 5/5; sensation 
intact; no tenderness; ligaments stable; gait 
normal; pain range 0-1; “pain with activity; 
Hips: normal ROM; Ankles: normal ROM 

Mild parapatellar tenderness; strength 5/5, 
sensation intact; Lachman’s, anterior drawer 
posterior drawer neg; “pain flare-ups with 
activity” 

§4.71a Rating 

10% 

10% 

10% 

10% 

 



The right and left tibia plateau stress fractures and pain resulting from them are well 
documented in the service treatment record (STR). The CI underwent aggressive PT with 
continued pain in the bilateral tibias with any activity. A right hip X-ray revealed right 
basicervical femoral neck region increased sclerosis. A bone scan demonstrated bilateral 
medial tibial plateau stress fractures, diffuse stress change of the knees, tibia, feet, and ankles. 
A bilateral knee X-ray indicated stress fractures. An Orthopedic consult noted that there were 
bilateral stress fractures. The record contains an initial temporary L3 profile from May to 
August 2000 and a permanent L3 profile was issued in August 2000 for bilateral medial tibial 
plateau stress fractures. The MEB narrative summary (NARSUM) examination approximately 2 
months prior to separation noted that although the CI’s symptoms resolved with decreased 
activity and he was essentially asymptomatic at the time of the examination, he would become 
symptomatic with any repetitive weight bearing motion such as running, marching or jumping. 
The examiner further opined that the CI was unlikely “to be able to return to full training status 
in the near future.” The NARSUM exam findings are summarized in the chart above. The CI 
was issued a permanent L3 profile for bilateral stress fractures with restrictions of no running, 
no jumping, and no marching and no repetitive load activity. The VA Compensation and 
Pension (C&P) examination 5 months after separation documented that activity such as stair 
climbing, long walks and prolonged standing caused painful flare-ups. The C&P exam findings 
are summarized in the chart above. X-rays document mild medial compartment joint space 
narrowing with very small osteophytes of the medial femoral condyle. 

 

The Board directs attention to its rating recommendation based on the above evidence. As 
described above the PEB bundled both conditions and rating analogous to 5003, assigned a 0% 
rating, based on degenerative arthritis without loss of joint space. The VA coded 
patellofemoral pain syndrome right knee and patellofemoral pain syndrome left knee VASRD 
5010 Arthritis, due to trauma, substantiated by X-ray findings with 5260 Leg, limitation of 
flexion of. Disability ratings of 10% were applied to each condition, seemingly based on painful 
motion. Shin splints and lower extremity stress fractures are typically rated analogous to 5262 
tibia and fibula, impairment of with the disability rating predicated upon slight, moderate, or 
marked disability. Both the MEB NARSUM and the C&P document pain with increased activity 
along with relatively asymptomatic periods after decreased activity as would be expected with 
stress fractures and stress reactions. This supports a rating of 10% for mild disability. 

 

After due deliberation in consideration of the totality of the evidence, the Board concluded that 
the right and left tibia stress fracture were each reasonably justified as unfitting. Considering 
all of the evidence and mindful of VASRD §4.3 Reasonable doubt, the Board recommends a 
disability rating of 10% coded 5299-5262 IAW VASRD §4.71a for the right tibia plateau stress 
fracture and 10% coded 5299-5262 IAW VASRD §4.71a for the left tibia plateau stress fracture. 

 

 

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 
bilateral tibial stress fractures condition, the Board unanimously agreed that the right tibial 


stress fracture and the left tibial stress fracture conditions were reasonably justified as 
separately unfitting. The Board, by a vote of 2:1, recommends right tibia stress fracture 
condition coded 5299-5262 and rated 10%, and left tibia stress fracture condition, coded 5299-
5262 and rated 10%, both IAW VASRD §4.71a. The single voter for dissent, who recommended 
rating each condition at 0%, voted for no recharacterization as the two 0% ratings combined 
would not materially change the PEB’s original rating but did not elect to submit a minority 
opinion. 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 

Right Tibia Stress Fracture 

5299-5262 

10% 

Left Tibia Stress Fracture 

5299-5262 

10% 

COMBINED (w/ BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120619, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxxx, DAF 

Acting Director 

Physical Disability Board of Review 

 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxx, AR20130007439 (PD201201532) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)