RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20030213 

 
NAME:  XXXXXXXXXXXXX 
CASE NUMBER:  PD1200724 
BOARD DATE:  20121219 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  Reserve  PV1/E-1  (Basic  Trainee),  medically  separated  for  a  left 
lower leg condition (stress fracture left tibia).  She did not respond adequately to conservative 
treatment and was unable to resume basic training.  She was issued a permanent L3 profile and 
referred  for  a  Medical  Evaluation  Board  (MEB).    Left  tibia  stress  fracture  condition  was 
forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were 
submitted by the MEB.  The PEB adjudicated the stress fracture left tibia condition as unfitting, 
rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  
The CI made no appeals, and was medically separated with that disability rating. 
 
 
CI CONTENTION: “Left tibial stress fracture along with right wrist cyst at bend of wrist.  The leg 
pain is still an annoyance today and Motrin 600 mg taken regularly for the pain.  Every day my 
legs  both  L&R  ache  after  being  on  them.    When  the  weather  changes,  standing  becomes 
painful.    Most  afternoon’s  [sic]  shins  feel  as  if  they  are  coming  out  of  being  asleep  and 
sensation  sometimes  lasts  for  hours.    Wrist  sometimes  immobilizes  the  use  of  right  hand,  
which Im [sic] right handed would love to have it removed if possible. “  
 
 
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 right leg and right wrist conditions are 
not within the Board’s purview.  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 20030121 

VA (2 Mos. Post-Separation) – All Effective Date 20030214 

Condition 

Code 

Rating 

Condition 

 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impairment  with  which  her  service-incurred  condition  continues  to 
burden her.  The Board wishes to clarify that it is subject to the same laws for service disability 
entitlements as those under which the Disability Evaluation System (DES) operates.  The DES 

Stress Fracture Left Tibia 

5099-5003 

0% 

↓No Additional MEB/PEB Entries↓ 

Combined:  0% 

Left Tibial Stress Fracture with 
Limitations 
Ganglion Cyst, Right Wrist 

Code 

5099-5010 
8799-8716 

Rating 
10% 
10% 

Exam 

20030409 
20030409 

Combined:  20% 

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 (DVA), operating under 
a  different  set  of  laws  (Title  38,  United  States  Code).    The  Board  evaluates  DVA  evidence 
proximal to separation in arriving at its recommendations, but its authority resides in evaluating 
the  fairness  of  DES  fitness  decisions  and  rating  determinations  for  disability  at  the  time  of 
separation.  The Board further acknowledges the CI’s contention for ratings for other conditions 
documented at the time of separation, and notes that its recommendations in that regard must 
comply with the same governance. 
 
Left Lower Leg Condition.  In August 2002 the CI sought care for left leg pain in the second week 
of  basic  training.    She was  diagnosed  with  a  tibial  stress fracture  and moved  to  the  Physical 
Therapy  Rehabilitation  Platoon  (PTRP).    Serial  X-rays  over  the  next  4  months  confirmed  a 
healing stress fracture and remained positive for fracture up to 2 months prior to separation.  
At the MEB exam, the CI reported left leg pain 2 of 10 in intensity with walking and 9 of 10 in 
intensity  with  running,  and  worsened  with  jumping,  marching,  squatting,  or  any  type  of 
strenuous activity.  The MEB physical exam demonstrated tenderness of the mid aspect of her 
left tibia, medially, soft calf, and no skin changes.  Most proximate X-rays, 2 months prior to 
separation, revealed abundant callus formation about the stress fracture and a bone scan was 
still positive for fracture.  At the VA Compensation and Pension (C&P) exam, referenced in the 
VARD after separation, the CI reported pain in the left leg after standing for 30 minutes lasting 
for about an hour and that she used the nonsteroidal, Motrin, intermittently for pain.  The C&P 
exam again referenced in the VARD of April 2003, demonstrated tenderness of the left tibia, no 
swelling and no Deluca observations. 
 
The Board directs attention to its rating recommendation based on the above evidence.  This 
rating includes consideration of functional loss lAW VASRD §4.10 (functional impairment), §4.40 
(functional loss), §4.45 (DeLuca), and §4.59 (painful motion).  The PEB and VA chose different 
coding options for the condition, but this did not bear on rating and both rated IAW §4.71a—
Schedule of ratings–musculoskeletal system.  The PEB’s DA Form 199 reflected application of 
the  USAPDA  pain  policy  for  rating  and  its  0%  determination  was  consistent  with  §4.71a 
standards.  The VA assigned a 10% rating coded analogous to 5010 which defaults to the 5003 
VASRD criteria and cited a 10% may be applied once to multiple joints if there is no limited or 
painful motion.  Deliberations ensued regarding whether or not a compensable rating could be 
supported under the analogous 5003 or any coding alternative.  With no limitation of motion 
due to pain documented in either the VA and MEB exams, a rating under any ROM code could 
only be justified with application of §4.40 (functional loss).  VASRD §4.40 states “a part which 
becomes painful on use must be regarded as seriously disabled;” and, both the MEB and VA 
examiners documented a consistent complaint of pain on use.  Likewise, the PEB cited unable 
to resume training due to pain on use.  All members agreed that a minimal compensable rating 
under the analogous 5003 code was therefore supported by application of §4.40.  The Board 
considered the VASRD code 5022 code for its clinical specificity and notes this also defaults to 
the 5003 criteria without achieving a higher rating.  The Board agreed there was no evidence of 
incapacitating episodes to support additional or a 20% rating under the 5003 code.  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  left  lower  leg  condition  and  the  action 
officer prefers an analogous code to 5022 for clinical specificity.   
 
 

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.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  As discussed above, PEB likely reliance on the USAPDA pain policy for rating 
left  lower  leg  condition  was  operant  in  this  case  and  the  condition  was  adjudicated 
independently of that policy by the Board.  In the matter of the left lower leg condition, the 
Board  unanimously  recommends  a  disability  rating  of  10%,  coded  5099-5022  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 her prior medical separation:   
 

VASRD CODE  RATING 
5099-5022 
COMBINED 

10% 
10% 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

Left Tibial Stress Fracture with Limitations 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120703, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXX, AR20130002245 (PD201200724) 
 
 
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)