RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04081
BRANCH OF SERVICE:  Army	BOARD DATE:  20150619
Seperation date:  20090828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Basic Training Recruit) medically separated for left hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  The CI was profiled to take the alternate aerobic portion of the Army physical fitness test in order to satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left inferior pubic rami stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “stress fracture of the left inferior pubic rami” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please Consider All Conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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/Naval 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 IPEB – Dated 20090815	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Left Inferior Pubic Rami	5299-5255	10%	Left Hip Strain	5252	10%	20100125	
			Residual Stress Fracture, Left Pelvis	5255	10%	20100125	
Other x 0  (Not in Scope)	Other x 8	
Combined:  20%	Combined:  80%	
*Derived from VA Rating Decision (VARD) dated 20100409 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Stress Fracture, Left Inferior Pubic Rami Condition. The CI developed pelvic pain during her second week of training.  The pain worsened and X-rays in April 2009 showed a stress fracture of the left inferior pubic rami (IPR).  She improved while on 30 day convalescent leave (crutches and bed rest) and upon return to duty, entered a physical therapy rehabilitation program.  After prolonged walking, standing and riding in rough vehicle, the pain returned.  Follow up X-rays in May 2009, showed healing of the left IPR fracture.  However, pain persisted and she was not able to perform the physical tasks to complete basic training.  She was referred for a MEB.

At the orthopedics narrative summary examination, dated 21 July 2009 (performed a month prior to separation), the CI reported her pain was constant, increased with walking and weight bearing, and was 4/10 in intensity but could reach 7/10.  Physical examination of the left hip showed forward flexion of 72 degrees with pain at 45 degrees, abduction at 45 degrees with pain, and extension 10 degrees with no pain.  There was tenderness to palpation along the site of the stress fracture and along the left abductor muscles of the hip.  There was no pain with external/internal rotation of the hips with the hip flexed at 90 degrees as well as the hip in neutral position.  There was no popping, snapping, or locking of the hip with range-of-motion (ROM).  She had a normal gait, muscle strength was 5/5 and the extremities were neurovascularly intact.  The examiner noted the condition was stable and should resolve in 9 months to a year.

Physical therapy examination, dated 22 July 2009, provided ROM measures of the hip.  The CI was able to cross legs, right over left and left over right.  There was no limitation of abduction causing motion to be lost beyond 10 degrees and there was no limitation of external rotation causing soldier to be unable to toe-out more than 15 degrees.  Hip extension and ROM was within normal limits.

At the VA Compensation and Pension exam performed 5 months after separation, the CI reported bone pain, tenderness, soreness, mostly on the left side of the pelvis.  Prolonged standing and walking prolonged periods caused more pain.  She could walk without assistive devices.  Examination of the left hip showed pain with motion, flexion to 120 degrees (125 normal), and extension 0 (20 normal) degrees.  Both lower extremities showed muscle strength Grade 5/5 with good muscle tone and strength.  No atrophy was noted.  The examiner noted the left hip pain was likely due to the left IPR fracture.  Residual stress fracture and left hip strain were diagnosed.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the stress fracture, left inferior pubic rami at 10% coded analogous to 5299-5255 (femur, impairment of malunion; slight hip disability).  The PEB rated the condition in consideration of functional loss IAW VASRD §4.10 (functional impairment), §4.40 (functional loss), §4.45 (reduction of joint movement) and §4.59 (painful motion).  The VA rated the left hip strain at 10% using code 5252 (thigh, limitation of flexion of) and residual stress fracture, left pelvis at 10% applying code 5255 citing tenderness.  The Board considered whether the rating of one condition is appropriate or if rating two separate disabilities was in violation of VASRD §4.14 (pyramiding).  The Board believed that coding all hip disability under 5252-5255 was the most appropriate approach as not to violate VASRD §4.14.  Under this coding approach, the Board then considered whether the hip disability was slight (10%) or moderate (20%).  The CI had a normal gait and muscle strength.  X-rays showed good progressive healing of the fracture.  All examinations documented non-compensable ROM measurements for the left hip in extension and flexion as required for rating under VASRD codes 5251, and 5253 respectively.  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 hip disability 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.  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 chronic left 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.

RECOMMENDATION:  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 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

06 JUL 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 AR20160003519 (PD201404081)

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:
CF:
( ) DoD PDBR
( ) DVA