RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02073
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040818

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

CI CONTENTION:  “Please consider all conditions.” [sic].  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:  

IPEB – Dated 20040719	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Pubic Ramus Stress Fracture	5003	0%	Left Hip Condition	5253	10%	20041014	
			History of Left Pelvic Stress Fracture	5299-5236	0%		
Right Hip Pain	Not Unfitting	Right Hip Condition	5253	10%		
Other x 0	Other x 6	
RATING:  0%	RATING:  40%	

ANALYSIS SUMMARY:  

Left Hip pain.  Pursuant to chronic left low pelvic (hip) pain in late 2003, a magnetic resonance image (MRI) of the CI’s pelvis revealed a left-sided stress fracture of the inferior pubic bone.  Due to persistent complaints of pain with extension into the left buttock and leg, the CI was permanently profiled with the sole diagnosis of “left inferior pubic rami stress fracture.”  Her MEB physical examination performed 2 months prior to separation noted a slightly antalgic gait and decreased painful motion of the left hip.  

At the VA Compensation and Pension (C&P) examination, the CI’s physical examination revealed normal posture and gait as well as painful and decreased motion of the left hip.  The goniometric 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. 
					
Left Hip (Thigh) ROM
(Degrees)	MEB ~2 Mo. Pre-Sep
(20040617) 	VA C&P ~2 Mo. Post-Sep
(20041014) 	
Flexion (125 Normal)	116/112/113	90	
Extension (20)	11/10/11	20	
External Rotation (45)	45/45/45	45	
Abduction (0-45)	28/27/30	45	
Adduction (45)	18/19/19	25	
Comment	painful motion	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Utilizing different codes, both the PEB and VA rated the left-sided stress fracture condition at 0% citing non-specifics and absent residuals, respectively.  Board members agreed that the pathology and clinical relevance near the time of Service separation did support the application of §4.59 (painful motion) for a maximum of 10% under the analogous code of 5099-5003.  There were no other codes available within VASRD §4.71a that were applicable to the CI’s diagnosis or disability nor documentation of incapacitating episodes which would provide for additional or higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left pelvic condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that right hip pain was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The right hip condition was not profiled or judged to fail retention standards.  The condition was reviewed and considered by the Board.  The case file did not contain any service treatment records that specifically implicated or identified a right-sided hip condition and therefore, Board members agreed that there was no performance based evidence that any sort of abnormality of the right hip significantly interfered with satisfactory duty performance.  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 a right hip condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the left pelvic stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended right hip condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Pelvic Stress Fracture 	5099-5003	10%	
COMBINED	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160007475, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure