RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01890
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E4, Administrative Specialist, medically separated for “multiple stress fractures” rated at 0%.   

CI CONTENTION:  The CI requested a review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031020	VARD - 20040701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Stress Fractures	5099-5003	0%	Stress Fractures... Healed	5299-8530	NSC	20040415	
Osteoporosis	5013	---%	Severe Osteoporosis	5013	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Multiple Stress Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen on 10 September 2002, 3 weeks after accession and was found to have a tender chest wall at multiple levels.  She then reported right hip pain in physical therapy on 14 November 2002.  A bone scan the next day showed bilateral fractures of all 12 ribs and sternum.  She was also noted to have stress reactions of the right inferior pubic ramus (IPR, pubic bone) and right sacroiliac joint (SIJ).  A repeat bone scan on 26 February 2003 showed that the stress fractures of the right IPR, right SIJ, and right distal tibia (shin bone near the ankle) were healing.  Stress changes of the knees, shins, ankles, and feet were noted.  A scan for osteoporosis on 19 March 2003 showed severe disease.  The CI was placed on medications for the osteoporosis and continued rehabilitation for the multiple, now healing, stress fractures and to build bone mass.  A rheumatology evaluation on 28 March 2003 noted that there was no obvious cause for the osteoporosis.  It was suggested that the CI have a parathyroid scan, which was done on 6 August 2003 and normal.  

The MEB NARSUM was dated 5 August 2003, 5 months prior to separation.  The CI reported the onset of chest and pelvis pain during basic training.  She denied any specific trauma.  She was limited to walking less than one mile and could not run or jump.  On examination, she was noted to have mild tenderness to palpation of the bilateral ribs and bilateral pubic rami, but no limitations in motion.  

A chest X-ray on 7 April 2004, 3 months after separation, was normal.  One week later at the VA Compensation and Pension (C&P) evaluation performed on 15 April 2004, the CI reported that she rode a bicycle for exercise and was in a job which was not very physically demanding.  On examination, there was no longer palpable tenderness over the sites of the prior stress fractures.  There was mild tenderness over the right groin; no etiology for this was documented.  No X-rays were obtained as the examiner opined that the stress fractures had healed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the multiple stress fractures condition 0%, coded analogously as 5003 (degenerative arthritis) noting that they were healing but that there was continued pain.  The VA did not service-connect the stress fractures condition, coded analogous as 8530 (to paralysis of the ilio-inguinal nerve).  The VA rater noted that the fractures were clinically healed.  The rationale for the coding choice was not clear to the panel.  The CI was noted to be healing at the time of the MEB NARSUM, 6 months prior to separation, and to be clinically healed by the time of the C&P examination 3 months after separation.  The panel found no route to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the multiple stress fractures condition.  

Osteoporosis.  The clinical history for the osteoporosis condition was captured above in the discussion of the multiple stress fractures.  The panel directed attention to its rating recommendation based on the above evidence.  

The PEB determined that the osteoporosis condition was an EPTS [existed prior to service] condition.  It was coded 5013 (osteoporosis with joint manifestations), but not assigned a rating.  The VA rated the osteoporosis condition 0%, also coded 5013, noting that the C&P examiner recorded that the condition was diagnosed while on active duty.  The panel noted that the manifestations of the osteoporosis, multiple atraumatic stress fractures, were first noted within weeks of accession.  In addition, the osteoporosis was noted to be severe at the time of diagnosis which is not consistent with an acute onset.  Regardless, the CI was under treatment and the stress fractures healed.  A chest X-ray shortly after separation was normal; the medical officer observed that the ribs and spine would also be evaluated and significant osteoporosis would be apparent.  The evidence supported a finding that the condition was either resolved or resolving at separation and that it no longer directly impaired duty.  Accordingly, no advantage would be provided to the CI even if it were found to be service-aggravated.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the osteoporosis condition.  

BOARD FINDINGS:  In the matter of the multiple stress fractures condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the osteoporosis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150709, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009251, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure