RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

           SEPARATION DATE:  20031124 

                               BRANCH OF SERVICE:  ARMY  

 
NAME:  XXXXXXXXXXXXXX                 
CASE NUMBER:  PD1200569                             
BOARD DATE:  20121030  
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this  covered 
individual  (CI)  was  an  active  duty  PFC/E-3  (45B/Small  Arms/Artillery  Repair)  medically  separated  for 
chronic hip and leg pain.  She developed multiple lower extremity complaints in 2002 (basic training) 
which persisted throughout the balance of her career.  Various stress fractures were diagnosed and she 
did  not  respond  adequately  to  treatment  for  continued  service  within  her  Military  Occupational 
Specialty.  She was consequently issued a permanent L3 profile and referred for a Medical Evaluation 
Board (MEB).  The condition (bilateral extremities combined) was forwarded to the Physical Evaluation 
Board  (PEB),  characterized  as  “chronic  hip  and  leg  pain  secondary  to  multiple  stress  fractures,”  and 
judged  to  fail  AR  40-501 retention  standards.    Also addressed  by the MEB  and  forwarded  on the DA 
Form 3947 were two additional conditions (as identified in the rating chart below) which were judged to 
meet  retention  standards.    The  PEB  adjudicated  the  bilateral  hip/leg  condition  as  a  single  unfitting 
condition, coded analogously to 5003 (degenerative arthritis) and rated 10%, referencing the US Army 
Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not 
unfitting.  The CI made no appeals, and was medically separated with a 10% disability rating. 
 
 
CI CONTENTION: The application states simply: “Migraine headaches, stress fractures.  Pain has gotten 
worse and is spreading (chronic hip and leg pain).” She does not elaborate further or specify a request 
for Board consideration of any additional conditions.  
 
 
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 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 
rating  for  the  unfitting  hip/leg  condition  is  addressed  below;  as  is  the  migraine  headache  condition 
specified in the application and determined to be not unfitting by the PEB.  The unrequested asthma 
condition, as well as any condition or contention not requested in this application, remain eligible for 
future consideration by the Army Board for the Correction of Military Records.  Also IAW DoDI 6040.44, 
the  Board’s  authority  is  limited  to  making  recommendations  on  correcting  disability  determinations.  
The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the 
fairness  of  PEB  rating  determinations,  compared  to  Veterans  Administration  Schedule  for  Rating 
Disabilities (VASRD) standards, based on ratable severity at the time of separation; and, to review those 
fitness  determinations  within  its  scope  (as  elaborated  above)  consistent  with  performance-based 
criteria  in  evidence  at  separation.    The  Board  acknowledges  the  CI’s  information  regarding  the 
worsening impairment with which the 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, operating under a different set of laws. 
 

 

RATING COMPARISON:   
 

Service PEB – Dated 20031014 
Condition 

Chronic Hip and Leg 
Pain 
Migraine Headaches 
History of Asthma 

Combined:  10% 

Ratin

g 
10% 

Condition 

Code 
5099-
5003 
Not Unfitting  Migraine Headaches 
Not Unfitting 

Stress Fractures, Lower 
Extremities 

Asthma 

VA* – Effective 20031125 
Code 
5099-
5003 
8100 
6200 

Combined:  10% 

Ratin

g 
10% 
0% 
NSC 

Exa
m 
STR
* 
STR 
STR 

*STR = Service Treatment Record.  No post-separation VA examinations in evidence until April 2012. 

 
 
ANALYSIS SUMMARY:  
 
Bilateral  Hip/Leg  Condition(s).    After  the  CI  was  placed  on  crutches  following  her  left  ankle  sprain  in 
basic  training,  she  developed  contralateral  leg  pain  as  well.    After  resuming  full  weight  bearing  she 
suffered persistent bilateral lower extremity pain variously in her feet, ankles, knees, and hips.  Earlier 
notes in the service treatment record (STR) document intermittent left ankle pain, tibial pain diagnosed 
as shin splints, left knee pain, and bilateral foot pain; progressing to the bilateral lower extremity multi-
joint complaints described in the narrative summary (NARSUM).  Multiple plain radiographs throughout 
the  clinical  course  were  normal.    A  bone  scan  performed  in  January  2003  was  interpreted  as  stress 
fractures of the left foot and right tibia, and areas of uptake (inflammation) in the hips (right > left) and 
lateral femurs.  A follow-up bone density study was normal.  There are numerous outpatient primary 
care, orthopedic and physical therapy entries in the STR.  All recorded a normal range-of-motion (ROM) 
for every involved joint.  Two of those noted painless ROM; none recorded painful motion.  Some notes 
describe an antalgic gait; and some record a normal gait.  The NARSUM rated the CI’s pain as “slight and 
frequent”;  and,  described  functional  limitations  with  running,  repetitive  jumping,  marching,  and  load 
bearing.  The NARSUM physical exam is excerpted below. 

No pain on palpation of the hips, upper legs, knees, lower legs, ankles or feet bilaterally.  
There is full range of motion of the hips, knees and ankles.  There are no abnormalities 
on visual examination and no leg length discrepancy.  There is no edema or effusion of 
the lower extremities.  Muscle strength is 5/5 bilaterally.  Sensory is intact. 

Further entries documented ligamental stability of the ankles and knees, and absence of meniscal signs 
for the knees.  As footnoted in the rating chart, there is no probative post-separation exam evidence 
from the VA.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The PEB and 
the VA (based on service evidence) applied the identical analogous code 5003 (degenerative arthritis), 
and  arrived at the  same  10%  rating.    Although  the PEB  referenced the  USAPDA  pain  policy,  the  VA’s 
rating  rationale  (citing  criteria  under  VASRD  §4.71a)  stated,  “A  diagnosis  of  chronic  hip  and  leg  pain 
secondary to multiple stress fractures was shown.  A higher evaluation is not warranted unless there are 
medical  findings  of  limited  or  painful  motion  of  individual  joints  on  examination.”    As  accurately 
portrayed in the VA’s rationale, 5003 yields a 10% rating for “2 or more major joints” in the absence of 
“incapacitating exacerbations;” and, there is no evidence for the latter.  The Board carefully deliberated 
the option of deriving separately compensable ratings for the 6 major joints encompassed in the single 
unfitting condition rated for disability.  To do so, however, the Board must conclude that any rating so 
derived  was  associated  with  separately  unfitting  impairment.    All  members  agreed  that  the  unfitting 
disability was clearly on the basis of combined effect, with no single joint defensible as autonomously 
unfitting.    No  single  joint  was  individually  profiled,  implicated  in  the  commander’s  statement,  or 
associated with distinctly unfitting clinical features by any STR entries.  Furthermore, there is no route to 
a  separately  compensable  rating  for  any  joint  even  if  the  fitness  objection  was  conceded.    That 
conclusion is strengthened by the VA’s failure to identify separately ratable criteria under §4.71a.  After 

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due  deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the 
Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of 
the bilateral hip/leg condition.   
 
Contended  Migraine  Headache  Condition.    There  is  a  single  STR  entry  documenting  “daily”  bilateral 
headaches associated with nausea and mild light sensitivity; diagnosed as “probable migraine.”  It was 
managed  by  “patient  education  on  triggers;”  and,  there  are  no  prescribed  medications  for  headache 
evidenced in the STR.  The MEB physical documented “migraine under control.”  The NARSUM did not 
elaborate  on  the  diagnosis,  other  than  to  comment  that  it  met  retention  standards.    The  VA  rating 
decision  stated  “0  percent  disability  evaluation  based  on  the  evidence  of  one  episode  of  headache 
diagnosed  as  probable  migraine.”    The  Board’s  main  charge  with  respect  to  this  condition  is  an 
assessment of the fairness of the PEB’s determination that it was not unfitting.  The Board’s threshold 
for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used 
for  its  rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable” 
standard.  The condition was not profiled; it was not implicated in the commander’s statement; and, it 
was not judged to fail retention standards.  There was no performance based evidence from the record 
that  the  headache  condition  significantly  interfered  with  satisfactory  duty  performance.    After  due 
deliberation in consideration of the preponderance of the evidence, the Board concluded that there was 
insufficient cause to recommend a change in the PEB fitness determination for the migraine headache 
condition; thus no additional disability rating can be recommended. 
 
 
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 bilateral hip/leg condition was operant in this case and it was 
adjudicated independently of that policy by the Board.  In the matter of the bilateral hip/leg condition 
and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the 
matter  of  the  contended  migraine  headache  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, therefore, recommends that there be no recharacterization of the CI’s 
disability and separation determination, as follows: 
 

 

Chronic Hip and Leg Pain Associated With Multiple Stress Fractures 

UNFITTING CONDITION 

VASRD CODE 
5099-5003 
COMBINED 

RATING 

10% 
10% 

 

 
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. 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

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SFMR-RB 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXX, AR20120020593 (PD201200569) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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