RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02427
BRANCH OF SERVICE:  Army	BOARD DATE:  20160616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2, Petroleum Supply Specialist, medically separated for “pelvic pain…” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 – Dated 20061121	VARD - 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pelvic Pain	5099-5003	10%	Residual Right Pubic Ramus and Coccygeal Fractures … Degenerative Disc Disease…	5298-5242	10%	20070228	
			Intermittent Sciatica to Right Lower Extremity…Degenerative 	8620	0%	20070228	
Left Ovarian Cyst	Not Unfitting	Left Ovarian Cyst	7615	NSC	20070228	
Asthma	Not Unfitting	Exercise-Induced Asthma	6601	NSC	20070228	
Depression	Not Unfitting	Pain Disorder…	9422	NSC	20070129	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Pelvis.  According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI injured her pelvis on the confidence course during basic training approximately 11 months prior to referral for MEB.  Hip diagnostic imaging (X-ray) showed a non-acute right inferior pubic ramus stress fracture.  A sacrum X-ray showed a possible fracture at the lower sacrum/upper coccyx.  Lumbosacral spine diagnostic imaging (MRI) showed a possible, likely old, nondisplaced inferior S5 fracture.  Diagnostic imaging (bone scan) showed no abnormalities of the sacrum, coccyx, or areas visualized.  At an orthopedic surgery evaluation the CI complained of pain involving her tailbone, right lateral low back, buttock, and groin areas.  She reported numbness and tingling down her entire right leg and denied leg weakness or loss of bowel or bladder function.  Pain was exacerbated by any activity including sitting, standing, walking, bending, and lifting.  The physical examination documented a normal gait and that the CI “moved easily in the room without difficulty.”  The lumbar spine examination revealed minimal tenderness along the spinous processes and paraspinal musculature.  There was no discomfort with flexion or extension.  The pelvis examination revealed tenderness over the right sacroiliac (SI) joint (significant), right anterior superior iliac spine (mild), right groin (to deep palpation), and coccyx.  There was minimal discomfort with pelvic compression.  The Patrick (assesses hip and SI joint pathology) test was positive on the right and the straight leg raise (SLR) test (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) was negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  Lumbar spine X-rays were unremarkable.  The impression listed right nondisplaced S5 fracture, right inferior pubic ramus stress fracture, and right sacroiliitis (SI joint inflammation).  The surgeon opined that the inferior pubic ramus stress fracture appeared to be healing and recommended a trial of injections for the sacroiliitis and coccyx fracture.  A lumbar spine MRI showed mild disc space degenerative change at L3-4, L4-5, and L5-S1.  At the 30 August 2006 family practice examination for the MEB, the CI complained of chronic tailbone and low back pain but denied neurological symptoms.  She reported the pain was improving with an anticonvulsant, was using less morphine, and was following up with pain management.  The musculoskeletal examination documented “able to sit directly on tailbone today without discomfort, full range of motion and squats today in examination without discomfort to pelvic, low back or tailbone areas.”  The back examination recorded “good flexion forwards and back today.”  The examiner recorded “complete documentation of history and physical on DD FORMS 2807-1 and DD 2808 in medical record.”

In the 12 October 2006 NARSUM, 4 months before separation, the CI complained of constant 9-10/10 low back and pelvis pain with “some sciatica sounding pain down the posterior aspect of the right lower extremity.”  Pain was exacerbated by any blow to the pelvis, or if she sat down too firmly, and was incompletely relieved by medications.  For the physical examination, the examiner referred to DD Forms 2807 and 2808 and examinations by family practice and pain management.  The examiner cited the findings of the X-rays, bone scan, and MRI.  The diagnosis listed chronic bony pelvic pain with evidence pubic symphysis injury, right pubis ramus fracture, and coccygeal fracture.  Pain management performed serial caudal and L5-S1 epidural steroid injections.  At a 7 November 2006 family practice encounter, the CI complained of 8/10 tailbone pain, lower back pain radiating to the legs, and numbness down back of the right leg.  The lumbosacral spine examination revealed abnormalities to palpation, a normal appearance, and no muscle spasm.  Neurodynamic tests (assess mechanosensitivity of neural tissues) revealed no physical findings for radiculopathy (nerve root irritation or injury).  The SLR and reverse SLR (assesses for herniated disc causing femoral nerve root [L2-L4] radiculopathy) tests were negative.  The coccyx showed no abnormalities and DTRs were normal.  The assessment listed chronic low back pain.

At the 28 February 2007 VA Compensation and Pension (C&P) examination the CI complained of chronic right pelvis and coccyx pain.  Pain was characterized as 10/10 and throbbing with associated radiation of numbness and tingling down the right leg.  Pain was exacerbated by sitting, standing, prolonged walking, and running and minimally relieved with medications.  The physical examination documented a normal gait without any assistive device.  The examiner recorded “She is noted to be able to easily get on and off the exam table without assistance.  She is also noted to be sitting squarely on her buttocks during portions of the exam.”  The lumbosacral spine examination revealed focal tenderness of the coccyx area with no abnormal spine contour, muscle spasm, or guarding.  Repetitive range-of-motion (ROM) was measured with a goniometer.  Flexion was 90 (90 normal), extension was 30 (30), right lateral flexion was 30 (30), left lateral flexion was 39 (30), and bilateral rotation was 30 (30) degrees.  With repetition, there was no loss of ROM due to pain, weakness, impaired endurance, incoordination, or instability.  Strength and DTRs were normal.  Lumbosacral spine and bilateral hip X-rays were normal.  A spine, sacrum, and coccyx X-ray showed a possible old healed pelvic fracture.  The diagnoses listed chronic right pelvic pain secondary to old pubic ramus fracture and coccydynia (tailbone pain) due to previous coccyx fracture.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the pelvic pain condition at 10%, analogously coded 5003 (degenerative arthritis) citing injury during basic training injury, constant 9-10/10 pelvic pain, X-ray findings of healing right inferior pubis ramus fracture and mild lumbar degenerative changes, daily narcotics use, and rated for moderate and frequent residual pain.  The VA also rated the pelvic pain condition at 10%, analogously rating 5298-5242 (coccyx, removal of-degenerative arthritis of the spine) based on the VA C&P examination 1 month after separation, citing focal coccyx region tenderness to palpation and muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour.  The thoracolumbar ROM values in the C&P examination did not attain the minimum 10% rating based upon the general rating formula for diseases and injuries of the spine.  Although the CI experienced occasional radiation of pain and numbness to the right lower extremity, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  There was no evidence of intervertebral disc syndrome or incapacitating episodes requiring bedrest prescribed by a physician.  While there was lumbar spine, right SI joint, and coccyx tenderness, there was no evidence of muscle spasm, abnormal spinal contour, or abnormal gait.  While there was evidence of a possible fracture at the lower sacrum/upper coccyx, there was disability for consideration under 5298 (coccyx, removal of).  There was no disability for consideration under 5250 (hip, ankylosis), 5251 (thigh, limitation of extension), 5252 (thigh, limitation of flexion), 5253 (thigh impairment of abduction, adduction, rotation), 5254 (hip, flail joint), or 5255 (femur fracture nonunion/malunion).  The Board agreed there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.40, §4.59 and §4.45).  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 pelvis condition.

Contended PEB Conditions:  Left Ovarian Cyst, Exercise-Induced Asthma, and Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that these contended conditions were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions 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 for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the pelvis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left ovarian cyst, exercise-induced asthma, and depression conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140521 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013601 (PD201402427)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA