RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03027
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Basic Trainee) medically separated for “painful post-fracture deformity of coccyx evaluated as removal of coccyx,” rated at 10%. 

CI CONTENTION:  “Please consider all conditions”

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 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 20080723	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Post Fracture Deformity of Coccyx Rated as Removal of Coccyx	5299-5298	10%	Irregular Angulation of the Coccyx	5298	0%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1 	
RATING: 10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080929 (most proximate to date of separation [DOS]).  
VARD 20111004 assigned a 10% evaluation for the CI’s Coccyx, removal based on “parital or complete, with painful residuals” effective 20010304.

ANALYSIS SUMMARY:  

Traumatic Deformity of the Coccyx.  During Basic Training the CI slipped on ice and landed directly on her buttock.  She developed instant pain over her tailbone.  Initial X-rays were inconsistent in stating the presence of a clear fracture, but did reveal an irregular angulation of the bone and this was interpreted as being consistent with a fracture.  Subsequent Orthopedic evaluation determined that the CI did not have a fracture, but rather the traumatic angulation of the tailbone was causing her persistent painful symptoms.  The Orthopedic examiner made comment that the CI’s condition was likely to be made worse with continuation of basic training and recommended a Medical Evaluation Board (MEB).  She was permanently profiled on 02 June 2008 with a diagnosis of low back pain status post coccyx fracture.  At the narrative summary (NARSUM) examination (30 June 2008; 5 weeks prior to separation) the CI endorsed intermittent, but daily tailbone pain worsened with sitting or lying on her back.  Her physical examination (PE) revealed minimal (non-painful) decreased range of motion (ROM) of her thoracolumbar spine and tenderness about the tip of her angulated coccyx.  The CI was noted to appear very uncomfortable with sitting and her gait was normal when walking.  Her diagnosis was coccyx pain with healed coccyx fracture.  Her condition was listed as stable.  A VARD dated 29 September 2008 noted that the CI ‘failed to report’ for a Medical Examination with the VA and hence there was no VA compensation filing that was accomplished at the time of this Board’s review.  Any impairment rating recommendation from this Board will be based upon the MEB examination and terminal encounter documents within the STR.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA chose the primary code of 5298 (coccyx; removal) for a 10% and 0% rating, respectively.  The PEB coded the condition analogously whereas the VA used a direct coding approach.  Board members first considered and agreed that the persistent painful symptoms in this case were residuals of the CI’s direct trauma received to her tailbone; and, although no portion of her coccyx was removed, code 5298 (analogously identified) was most appropriate from a diagnostic standpoint.  The maximum rating under this code is 10% which is equivalent to the PEB’s current value.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the painful coccyx condition was appropriately recommended in this case. 

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the painful coccyx 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 20140607, 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 AR20160005004 (PD201403027)

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