RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01005
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Trainee, medically separated for “left inferior pubic ramus stress fracture,” with a disability rating of 0%.

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  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 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 PEB - 20080305	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Inferior Pubic Ramus Stress Fracture	5099-5003	0%	Status Post Stress Fracture, Pubic Bone…Left Hip	5252-5010	10%	20080731	
COMBINED RATING:   0%	COMBINED RATING OF ALL VA CONDITIONS:  20%  	

ANALYSIS SUMMARY:  

Left Inferior Pubic Ramus Stress Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip condition began in March 2007 during basic training without any history of trauma.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 18 October 2007, 5 months before separation, the CI did not elaborate regarding her condition.  The physical exam was marked “normal.”  At the MEB NARSUM examination dated 1 February 2008, 2 months before separation, the CI reported pain with running and stair climbing and denied pain at rest or with walking.  Left hip flexion was to 115 degrees (normal 125), extension was 10 degrees (normal 20), and abduction was to 30 degrees (normal 45 degrees).  At the VA Compensation and Pension (C&P) examination in July 2008, performed 4 months before separation, the CI reported intermittent pain with running, reduced productivity at work, and 30-60 minute flare-ups that occurred 2-3 times per month.  Physical exam showed pain with internal rotation and adduction (crossing legs).  Adduction was to 25 degrees (normal 45), and flexion, extension, and external rotation were all normal.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (degenerative arthritis), citing the USAPDA Policy and Guidance Memo #13.  The VA assigned a 10% rating using an analogous 5252-5010 code (thigh, limitation of flexion; traumatic arthritis) based on the VA C&P examination 4 months after separation, citing painful motion during adduction and internal rotation.  Application of VASRD §4.59 (painful motion), was supported by STR documentation (painful motion and mechanical limitations) to support a 10% rating coded as 5010-5003 or 5253-5010 (thigh, impairment of; limitation of adduction; traumatic arthritis).  There was no STR evidence of ankylosis (5250), abduction limited to 10 degrees (5253), or flexion limited to 30 degrees (5252) to support a higher rating.  None of the other hip/thigh joint codes (5254, 5255) were applicable to this case and would not have resulted in a higher rating.  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 inferior pubic ramus stress fracture, analogously coded 5253-5010.  

BOARD FINDINGS: In the matter of the left pubic ramus stress fracture, the Board unanimously recommends a disability rating of 10%, coded 5253-5010 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Inferior Pubic Ramus Stress Fracture	5253-5010	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140218, w/atchs
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 XXXXXXXXXXXXXXXXXX, AR20160005838 (PD201401005)  

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA