RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01488
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  0060721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Military Police, medically separated for “chronic pelvic bone, left hip, and left knee pain” and “chronic non-radiating mid back pain” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  She was not evaluated for a contended traumatic brain injury (TBI) condition.  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 – 20060622	VARD - 20070403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pelvic Bone, Left Hip, and Left Knee Pain	5099-5003	10%	Left Inferior Pubic Ramus Fracture, Left Pubic Symphysis
Fracture, Sacroiliac Joint Separation and Left Femur
Fracture	5299-5255	30%	20061102	
Chronic Non-Radiating Mid Back Pain	5237	10%	Chronic Back Strain of the Mid Back	5237	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Pelvic Bone, Left Hip, and Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pelvic, left hip, and left knee pain condition began in March 2004 after a motor cycle accident.  The CI underwent open reduction and internal fixation of the left femur and plating with four pins for the pelvic fracture.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded pelvic pain and left knee pain for PEB adjudication. The MEB NARSUM dated 30 March 2006, 4 months before separation, documented persistent pelvis and left knee pain.  The physical examination demonstrated left pelvis tenderness to palpation, significant right posterior hip pain, limitation of hip motion bilaterally, and an audible and palpable right hip “noise” with motion.  The left knee examination demonstrated lateral laxity with a solid end point and mild medial joint line tenderness.  The gait and knee range of motion were normal. The knee appearance was normal except for surgical scars.  At the VA Compensation and Pension (C&P) examination on 2 November 2006 a normal gait, performed 3 months after separation, the CI reported persistent left knee and bilateral hip pain which radiated down the distribution of the sciatic approximately twice a month. She also reported avoidance of weight bearing recreational activities due to pelvic, left and hip pain.   Physical examination showed a normal gait, normal lower extremity muscle strength bilaterally, and asymptomatic surgical scars.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pelvic bone, left hip and left knee pain conditions as a single unfitting condition at 10% (coded 5099-5003, [Analogous to degenerative arthritis]), citing rated for pain slight/frequent ( US Army Physical Disability Agency [USAPDA] pain policy {AR 635-40}).  The VA also rated the left inferior pubic ramus fracture; left pubic symphysis fracture; sacroiliac joint separation and left femur fracture conditions as a single disability rated at 30% (coded 5299-5255, [analogous to femur, malunion of]), citing significant function impairment marked hip disability as demonstrated by external rotation of the hip and pain with any lifting and sometimes walking.  The VA additionally rated the left knee and thigh surgical scars at 0% under code 7805 (scar(s), other).  The Board first considered whether the left hip, pelvic bone and knee condition “bundled” by the PEB could be reasonably justified as separately unfitting.  The left knee and pelvic pain conditions were profiled and implicated in the commander’s statement.  Board members agreed that each condition could be justified as separately unfitting. Board members that there was no compensable limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or abduction (5260, 5261, 5251, 5252, 5253); however, there was evidence of painful motion with functional loss supporting a 10% rating for the left hip/pelvic pain and left knee pain conditions (based on VASRD §4.59 [painful motion], §4.40 [functional loss] and §4.45[the joints]).  The Board noted that the left hip and pelvic pain resulted in the same functional impairment and therefore, IAW §4.14 (avoidance of pyramiding) could not be separately rated.  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 hip/pelvic condition and 10% for the left knee condition.   

Chronic Non-Radiating Mid-Back Pain.  According to STR and the MEB NARSUM, the CI’s mid-back pain began in March 2005 due to pregnancy.  The MEB NARSUM 4 months before separation documented persistent back pain with an occasional limp.  The physical examination demonstrated flexion limited to 85 degrees (normal 90), marked tenderness of the upper lumbar and lower thoracic vertebra, and tenderness of the thoracolumbar paravertebral muscles.  The gait was normal and radicular testing was negative.  At the VA C&P examination performed three months after separation, the CI reported the onset of mid-back pain in 2003 which was attributed to large breasts.  The CI underwent breast reduction surgery in 2004.  She reported persistent mid back pain.  The physical examination showed thoracolumbar vertebral and paraspinal tenderness to palpation.  There was pain limited extension, left lateral flexion and right lateral flexion to 20 degrees (normal 30).

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the mid back pain condition 10% coded 5237 (lumbosacral strain), citing tenderness.  The VA also rated the condition 10% coded 5237, citing functional loss due to pain.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the MEB.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  

After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the mid back pain condition.  

BOARD FINDINGS:  In the matter of the chronic pelvic bone, left hip and left knee pain condition, the Board unanimously determined that they were separately unfitting and recommends a disability rating of 10%, for the left hip/pelvic condition and 10 % for the left knee condition coded 5003 IAW VASRD §4.71a.  In the matter of the mid back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pelvic Bone and Left Hip Pain	5003	10%	
Left Knee Pain	5003	10%	
Chronic Non-Radiating Mid-Back Pain	5237	10%	
COMBINED 	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140317, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 27 2016

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, AR20160010972 (PD201401488)

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual's separation as a permanent disabiiity retirement with the combined disability rating of 30% effective the date of the individual's original medical separation for disability with severance pay.

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:

a. Providing a correction to the individual's separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA