RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  MARINE CORPS 
SEPARATION DATE:  20021015 

 
NAME:  XXX 
CASE NUMBER:  PD1200966 
BOARD DATE:  20120220 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  PVT/E1,  (9900/Recruit),  medically  separated for  a 
stress  fracture  of  the  right  upper  sacrum.    Within  days  of  beginning  recruit  training,  the  CI 
sought treatment for various musculo-skeletal complaints.  Despite conservative management, 
she continued to have pain in multiple areas.  Because of the nature of the injuries and the 
projected  prolonged  healing  time,  it  was  recommended  she  be  removed  from  basic  training 
and be referred for a Medical Evaluation Board (MEB).  The MEB determined that pathologic 
fractures  of  the  tibia,  fibula  and  other  specified  site  and  disorder  of  bone  and  cartilage, 
unspecified, did not meet retention standards and forwarded these to the Physical Evaluation 
Board (PEB) for adjudication.  The PEB adjudicated the right upper sacrum stress fracture as 
unfitting, but used two codes, 5284 and 5294, each rated 10%, with application of the Veteran’s 
Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  stress  fracture  of  the  left  calcaneus, 
moderate  osteopenia  of  the  lumbar  spine  and  stress  fracture  of  the  left  distal  tibia  were 
determined  to  be  Category  II  conditions  which  contribute  to  the  unfitting  condition  (but, 
implied, are not separately unfitting).  The CI made no appeals and was medically separated 
with a 20% disability rating. 
 
 
CI  CONTENTION:    “I  would  like  to  have  previous  Med  Board  findings  reviewed  after  being 
denied VA benefits.” The CI elaborated no specific contention in her application.   
 
 
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 Board 
determined that the contention by the CI encompassed all the PEB conditions and that that all 
are, therefore, within the purview of the 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 Naval Records. 
 
 
RATING COMPARISON:   
 

VA (Failed to report for Exam) 

Service IPEB – Dated 20020821 
Condition 

Code 
5284 
5294 

Rating 
10% 
10% 

Right Upper Sacral Stress Fx 
Stress Fx L Calcaneus 
Mod Osteopenia L Spine 
Stress Fx L Distal Tibia 

CAT II 
CAT II 
CAT II 
↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Condition 

R Upper Sacral Stress Fx 
Stress Fx L Calcaneus 
Osteopenia L Spine 
Stress Fx L Distal Tibia 

All conditions were NSC due to the failure by the CI to appear for a VA examination. 
 
 

Code 
5235 
5284 

5013-5237 

5262 

Rating 
NSC 
NSC 
NSC 
NSC 

Exam 
NA 
NA 
NA 
NA 
NA 

0% X 0 / Not Service-Connected x 4 

Combined:  NA 

ANALYSIS SUMMARY:  The CI was initially evaluated for her left ankle on 08 February 2002, her 
12th day of active duty.  She stated that she had twisted her ankle and a sprain was diagnosed.  
She initially responded well to conservative management, but her symptoms recurred and she 
was  diagnosed  with  left  Achilles  tendonitis.    Over  the  next  few  months,  she  was  seen  on 
multiple occasions for various musculo-skeletal complaints.  X-rays of the left ankle and right 
hip on this date were normal on 19 April 2002, but the left calcaneus and distal tibia showed 
stress fractures on X-ray.  The calcaneal stress fracture was noted to be healing on a repeat X-
ray on 20 May 2002.  A bone scan 3 days later showed increased uptake in the right sacrum and 
a  magnetic  resonance  imaging  (MRI)  exam  the  following  day  confirmed  a  right  sacral  stress 
fracture.  A bone density scan, also on 24 May 2002, revealed moderate osteopenia.  She was 
treated with duty restrictions and medications to increase bone mass.  Although it was noted 
that her stress fractures were healing, it was determined that the recovery would be prolonged 
and that she should be removed from basic training.  The narrative summary (NARSUM) was 
dictated 5 June 2002, 4 months prior to separation.  It noted that the pain in the left distal tibia 
and left calcaneus was resolving, but persistent in the right sacrum.  The physical examination 
was remarkable for tenderness over the right sacrum, left distal tibia and calcaneus with some 
edema of the left lower leg.  Range-of-motion (ROM) of the back was normal.  The osteopenia 
was  noted  to  have  existed  prior  to  enlistment,  but  the  stress  fractures  of  the  left  tibia  and 
calcaneus as well as that of the right sacrum did not exist prior to service (EPTS).  She was still 
using crutches at an orthopedic examination a week later; the examiner noted that the stress 
fractures  were  healing.    The  CI  failed  to  report  for  her  Veterans  Affairs  Compensation  and 
Pension (C&P) exam scheduled for 13 July 2004.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  gave  a  10%  rating  right  upper  sacrum,  coded  5284  (foot  injuries),  and  10%  code  5294 
sacro-iliac  injury  and  weakness.    The  Joint  Disability  Evaluation  Tracking  System  (JDETS) 
worksheet  awarded  10%  coded  5284  for  the  stress  fractures  of  the  left  distal  tibia  and  left 
calcaneus  conditions  and  10%  for  the  right  sacral  stress  fracture  and  osteopenia  conditions 
coded 5294.  The VA adjudicated all conditions as not service-connected and denied all claims 
due no evidence of post treatment and the failure of the CI to report for the VA examination.  
Although the CI had an antalgic gait and was using crutches, the orthopedist had concluded that 
the  stress  fractures  were  healing.    The  Board  noted that the typical  natural history  of  stress 
fractures is complete healing once removed from the source of the stress and that the most 
likely explanation for their onset was the increase in activity during basic training.  There is no 
evidence in the record that a permanent condition was present at separation.  Osteopenia is 
not  an  acute  condition.    Although  it  was  diagnosed  shortly  after  accession,  this  was  almost 
certainly  present  prior  to  accession  and  unmasked  with  the  vigor  of  basic  training,  as 
manifested  by  the  multiple  stress  fractures.    IAW  DoDI  1332.38  E3.P4.5.4.,  the  Board 
determined that the most likely clinical picture is that the osteopenia EPTS without aggravation 
and that the manifestations (stress fractures) were self-limited.  The expectation is that all the 
conditions will resolve over time with treatment, begun while on active duty, and removal from 
the stressful activities.  Accordingly, no disability rating is warranted.  However, the Board does 
not recommend a rating lower that what was adjudicated by the PEB.  The Board also noted 
that the PEB had cited diagnostic code 5284 (foot injuries) under the back condition.  The Board 
concluded that this most likely was an administrative error in the printing of the PEB document; 
however since the overall rating is not influenced by the specific diagnosis code used, the Board 
recommended no change to the diagnosis code.  Thus, after 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  for  any  of  the 
conditions. 
 
 

2                                                           PD1200966 

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.  In the matter of the stress fracture of the right upper sacrum condition and 
IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In 
the matter of the left tibial and calcaneus stress fracture as well as the osteopenia contended 
conditions, the Board unanimously recommends no change from the PEB determinations as not 
separately  unfitting.    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:   
 

VASRD CODE 
5284 - 5294 
COMBINED 

RATING 
10 + 10% 

20% 

Stress Fracture of Right Upper Sacrum 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120625, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 
 
 

 

xx 
Acting Director 
Physical Disability Board of Review 

3                                                           PD1200966 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW  
                                        BOARDS  

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

Ref:   (a) DoDI 6040.44 

             (b) CORB ltr dtd 04 Apr 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR 
that the following individual’s records not be corrected to reflect a change in either characterization 
of separation or in the disability rating previously assigned by the Department of the Navy’s 
Physical Evaluation Board: 
 
 
 
 
 
 
 
 
 
 
 
 

-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
-  xformer USN  
-  xformer USMC 
  
 

 
 
 
 
 
 
 
 
 
 
 

 

 

     
 
 
 
 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  x 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

4                                                           PD1200966