RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00329
BRANCH OF SERVICE:  Army	BOARD DATE:  20150306
SEPARATION DATE:  20060228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Calvary Scout) medically separated for back pain status post (s/p) fractured pelvis (healed).  The back pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent U3/L3 profile and referred for a Medical Evaluation Board (MEB).  The back pain, characterized by the MEB as “persistent back pain, mid-thoracic to upper lumbar area,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “persistent back pain…fractured pelvis, same accident, has healed” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The diagnosed condition was worse than what it was evaluated on.  In addition to MEB/PEB failing conditions there were additional diagnosed issues not evaluated.”

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:

Service IPEB – Dated 20060120	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Back Pain…Fractured Pelvis (Healed)	5237	10%	S/P Healed Fractures of the Sacrum and Right Inferior Pubis Ramus	5299-5236	10%	20060606	
			Post-Traumatic DDD of the Thoracic and Lumbar Spine w/Chronic Thoracolumbar Strain	5242	10%	20060606	
Other x 0 (Not in Scope)	Other x 9	
Rating:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20060818 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Back Pain With Healed Pelvic Fracture.  The narrative summary (NARSUM) and treatment record noted the CI had acute onset of back pain with a pelvic fracture (right inferior pubic ramus and multiple non-displaced fractures of the right sacrum) in February 2005 following a HMMWV rollover.  “Originally, his most intense pain was in the area of the fractured pelvis, but that pain has resolved.  He also had pain in his lower thoracic and upper lumbar area, and that pain is persistent.”  The pain was constant, aggravated by activities (especially sudden movements), interfered with sleep and was not relieved by lying down.  The pain did not radiate and there were no radicular symptoms.

The MEB physical exam DD Form 2808, Report of Medical Examination, noted decreased spine flexion and extension with tenderness to palpation.  The NARSUM exam documented a normal appearing back with “reasonable agility, although with some evidence of discomfort with certain movements.”  Back flexion was to hands 6 inches from the floor, with normal lateral bending and hyperextension limited by “a small spasm.”  There was back tenderness and positive straight leg raising (for radicular or stretch signs) reproducing back pain.  The CI had normal toe and heel walk, no muscle atrophy and no lower extremity sensory or reflex deficits.  Imaging documented mild thoracic degenerative disc disease with mild thoracic disc bulges without impingement, and right inferior ramus fracture with an orthopedic note indicating the fracture was well healed.  Formal MEB active range-of-motion (ROM) measurements from 17 November 2005 showed pain limited ROM (as charted below) and normal strength.

At the VA Compensation and Pension exams performed 3 months after separation, the CI reported a similar history as above.  Thoracolumbar exam documented pain limited motion as charted below.  There was “localized tenderness with preserved spinal contour.”  There was no spasm, guarding or weakness.  Straight leg raise was negative with no evidence of intervertebral disc syndrome.  Neurosensory exam was normal.  The exam of the pelvis and right hip included subjective complaints of “no weight bearing pain, but does experience a pulling sensation and popping noise with slight discomfort on abduction of his hip, which is only momentary, and during the motion.”  Physical exam was negative for limited or painful motion, tenderness or other objective findings.  The examiner’s summary indicated that the CI “has residual discomfort on abduction, likely related to scar tissue in the soft tissues.”

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB/PT ~ 3 Mo. Pre-Sep	VA C&P ~ 3 Mo. Post-Sep	
Flexion (90 Normal)	85,85,85	75	
Combined (240)	235	225	
Comment	Pain at end range; 5/5 strength	Painful motion; normal posture and gait; + tender; no spasm, guarding or weakness; 6 degrees thoracic scoliosis noted	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB disability description specified persistent back pain and additionally noted a healed fractured pelvis from the same accident.  The PEB rated the condition at 10% coded 5237 (lumbosacral strain) and cited “full passive range of motion.  Tenderness and spasm on exam for which rated.”  Reference to passive ROM was likely application of AR 635-40, B-29 for rating limited motion only on a mechanical basis.  The VA rated the back condition at 10% coded 5242 (degenerative arthritis of the spine) and additionally rated the pelvic fracture at 10% coded 5236 (sacroiliac injury and weakness).  The unfitting back condition had clear evidence of painful motion and tenderness with no evidence of abnormal gait or abnormal contour due to guarding or spasm.  There was no evidence of ROM limitation of flexion to 60 degrees or combined ROM of 120 degrees for a higher rating, nor was there evidence of incapacitating episodes.  All exams proximate to separation warranted a 10% thoracolumbar spine rating.

The Board next considered if the healed pelvic fracture condition was separately unfitting and ratable.  There was no MEB or NARSUM pelvis/hip diagnosis, no profile for the pelvis/hip, and limited exam findings attributable to the pelvis/hip.  The Board consensus was that the PEB disability description was a de-facto finding of a not unfitting pelvic fracture condition, and that there was not sufficient evidence for a separately unfitting and compensable pelvis/hip 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 AR 635-40 for rating the back condition was likely operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the back and pelvis condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140109, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXXXXXXX AR20150014366 (PD201400329)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)