RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02897
BRANCH OF SERVICE:  Army	BOARD DATE:  20151230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Trainee - Motor Transport Operator) medically separated for left hip pain, rated 10%.  

CI CONTENTION:  The CI requested that the Board review all of her conditions.  The 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 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 20080226	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Inferior Pubic Ramus Stress Fracture…	5099-5003	10%	Status Post Left Pubic Ramus Stress Fracture with
Chronic Left Hip Strain	5236-5255	10%	20080626	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 5 	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20081016 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Inferior Pubic Ramus Stress Fracture.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s left hip/pelvic condition began in September 2007 during Basic Training.  Radiographs confirmed a stress fracture of the left inferior pubic ramus (pelvis) with good healing and there was no surgical indication.  Despite treatment, the CI’s left hip/pelvis condition remained painful and prevented return to training/duty.  

At the MEB NARSUM examination on 24 January 2008 (3 months before separation), the CI reported left pelvic pain and the CI was unable to run, carry a rucksack, walk more than half a mile, squat or kneel without pain.  The MEB physical exam noted a slightly antalgic gait due to pain.  There was tenderness to palpation over the inferior left pubic ramus and motor function was normal.  Sensory and neurovascular testing was normal.  The goniometric range-of-motion (ROM) from physical therapy (the same day) indicated painful motion with severe guarding and is summarized below.  

At the VA Compensation and Pension (C&P) examination on 26 June 2008, performed 2 months after separation, the CI reported left hip pain of 7/10 with radiation into the left buttocks and leg, made worse by activity or cold.  Treatment included narcotic and narcotic-like pain reliever medications.  Physical exam showed a normal gait with equal leg lengths.  Lower extremity strength, sensation and reflexes were normal. There was left hip weakness and guarding of movement with painful ROM as charted below. 

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.  

Left Hip (Thigh) ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
	VA C&P ~2 Mo. Post-Sep
	
Flexion (125 Normal)	85	90	
Extension (20)	5	30	
External Rotation (45)	-	40	
Abduction (0-45)	20	30	
Adduction (45)	-	25	
Comment	Slight antalgic gait; tender; 	Normal gait; painful motion; weakness, guarding, painful	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 10% (coded analogous to 5003, degenerative arthritis), citing decreased ROM, pain and the USAPDA pain policy.  The VA also rated the left hip condition 10% (coded 5236-5255, sacroiliac injury and weakness-impairment of femur), citing slight hip disability from weakness, guarding and pain-limited hip motion.  All exams documented pain-limited left hip motion to the 10% rating level (IAW VASRD §4.59, or code 5251 for extension limited to 5 degrees at the MEB).  The left pelvic/hip condition was adjudged to indicate slight hip disability and a higher rating of 20% for moderate disability, or hip flexion limited to 30 degrees or abduction limited to 10 degrees was not supported by the record of evidence.  There was no higher rating achievable under rating using the spine formula criteria analogous to code 5236.  

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 left inferior pubic ramus stress fracture 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 the USAPDA pain policy for rating the left inferior pubic ramus stress fracture condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left inferior pubic ramus stress fracture 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, 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 20140601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160004502 (PD201402897)

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 
( ) OVA