RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01475
BRANCH OF SERVICE:  Army	BOARD DATE:  20150122
SEPARATION DATE:  20040329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Interrogator) medically separated for osteitis pubis with persistent pubic symphyseal pain and scoliosis with recurrent thoracic back pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The osteitis pubis and scoliosis were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic recurrent pelvic pain diagnosed as osteitis pubis” as unfitting, rated 0% with application of US Army Physical Disability Agency (USAPDA) pain policy.  
“Recurrent thoracic back pain attributed to moderate (12 degree) scoliosis, a preexisting developmental abnormality” was determined to be unfitting but unratable due to existed prior to service (EPTS) without permanent service aggravation.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Osteitis pubis was not caused by “adult onset scoliosis”; and after discharge – neck pain; muscle spasms; and pubic pain were all successfully treated by chiro and interspacial steroid injections  Requiring me to sit at desk 8 hrs a day learning Korean; and being required to ruck at an Infantry standard - caused spinal sublarations that could have been treated immediately – wearing a helmet on top of pinched discs made conditions worse.  I missed appointment in Jackson in 05 because I went to Iraq as a civilian to continue serving my country.”  [sic]

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to 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 at the time of separation.  The Board 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 Board 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:

IPEB – Dated 20040205	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pelvic Pain/Osteitis Pubis	5099-5003	0%	Ostetitis Pubis/Pubic Pain	5022-5252	NSC*	20040505	
Thoracic Back Pain/Scoliosis	EPTS	---%	Mild Scoliosis (Back Disorder with Muscle Spasm)	5299-5237	NSC*	20040505	
Other x 0 (Not In Scope)	Other x 7 	
RATING:  0%	RATING:  0%	
  *Original VA Rating Decision (VARD) dated 20040505 deferred rating decisions for both conditions.  Second VARD dated 20050301 determined both conditions Not Service Connected.  

ANALYSIS SUMMARY:

Osteitis Pubis with Persistent Pubic Symphyseal Pain.  According to service treatment records (STRs) and the MEB narrative summary (NARSUM), the CI experienced pain at the front of her pelvis diagnosed as osteitis pubis.  Clinic examination on 4 November 2003, noted a history of pubic symphysis pain since the birth of her last child (November 1996, over 3 years prior to entry into service), which had significantly worsened to nearly incapacitating.  There had been no specific injury other than physical and military training.  Examination was noted to show tenderness in the area of the pubic symphysis.  The MEB NARSUM performed on 5 January 2004, recorded report of pubic pain with nearly all activities.  On examination toe and heel walking were intact without difficulty.  At the time of the VA Compensation and Pension (C&P) examination performed on 5 May 2004, the CI reported continued pubic pain with activity.  On examination there was tenderness of the pubic bone.  An X-ray pelvis of the pelvis was normal with no radiographic changes of osteitis pubis.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the osteitis pubis with persistent pubic symphyseal pain 0% with application of the USAPDA pain policy.  The STRs reflected functional loss due to pubic symphysis pain with activity diagnosed as osteitis pubis.  There is no specific diagnostic code in the VA Schedule for Rating Disabilities (VASRD) for the pubic symphysis however in accordance with VASRD §4.40 a 10% rating is supported by the functional loss recorded in the service treatment records.  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 osteitis pubis condition (5099-5022).

Recurrent Thoracic Back Pain with Scoliosis.  STRs reflected care for recurrent thoracic level back pain with spasms without any specific injury.  X-rays demonstrated the presence of scoliosis of the spine, a developmental condition.  No other abnormality was noted on examinations or X-rays and providers considered the scoliosis to be a significant factor in her pain.  The MEB NARSUM noted the thoracic back pain was aggravated by activities such as sit-ups.  Other than the scoliosis, the examination was normal.  At the VA C&P examination performed on 5 May 2004, a month after separation, the CI reported intermittent upper back pain occurring once a month and lasting 4 days.  There was no history of specific injury or trauma.  The examination was normal and X-rays showed mild scoliosis.  According to the CI on her application, the pain was treated successfully after separation by chiropractic and injections.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB determined the recurrent thoracic pain attributed to scoliosis EPTS without service aggravation and therefore did not provide a rating.  In accordance with DoD policy, conditions which EPTS and are not permanently aggravated by service beyond the natural history of the condition are not compensable.  Scoliosis is condition which develops with skeletal growth and therefore existed prior to entry into military service.  There was no evidence of injury or disease in service which would cause or aggravate the scoliosis condition.  
The thoracic pain was aggravated by strenuous activities but no permanent injury was shown to have resulted from those activities.  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 the recurrent thoracic back pain attributed to scoliosis condition.

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 chronic recurrent pelvic pain diagnosed as osteitis pubis was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic recurrent pelvic pain diagnosed as osteitis pubis condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5022IAW VASRD §4.71a.  In the matter of the recurrent thoracic pain attributed to scoliosis condition the Board unanimously recommends no change in the PEB adjudication.  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:

CONDITION	VASRD CODE	RATING	
Chronic Recurrent Pelvic Pain Diagnosed As Osteitis Pubis	5099-5022	10%	
Recurrent Thoracic Pain Attributed To Scoliosis	EPTS	--	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150009868 (PD201301475)

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		
CF: 
(  ) DoD PDBR
(  ) DVA