RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04099
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20050328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-1, (Petroleum Supply Specialist Trainee) medically separated for “back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that not all of her conditions were rated and that she should have been discharged with a 100% rating.  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:  

SERVICE PEB - 20050205	VARD - 20050816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain	5237	10%	Residuals of Fractured Pelvis, Right Femur, Right Tibia, Left clavicle, Broken Ribs, Tail Bone, and Traumatic Brain Injury	8045	0%	STR	
Right Femoral Fracture	Not Unfitting					
Right Tibia Fracture						
Left Clavicular Fracture						
Right Common Peroneal Mononeuropathy						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Back Pain as Residual Post Pelvic and Sacral Injuries.  According to military and civilian treatment records, the CI’s back pain condition began in December 2003 after a motor vehicle accident (MVA) that caused multiple pelvic and sacral fractures.  Immediate surgery included external fixation of the pelvis and internal fixation of the right femur and tibia.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “status post open pelvic fracture” and “status post left non displaced sacral fracture” for PEB adjudication.  

At a neurologic consultation in June 2004 (9 months before separation), the CI reported lower back pain and use of a cane for ambulation.  The physical examination showed tenderness of the sacroiliac joint bilaterally.  The CI was not present at the time of dictation of the Medical Evaluation Board (MEB) narrative summary (NARSUM) dated July 2004 (8 months before separation); therefore, the examiner documented information gathered from the primary care physician where the CI was receiving treatment.  At the time of the report, the CI was full weight bearing, used a walker for community distance ambulation, and could sometimes ambulate at home without a walker.  On physical examination, an antalgic gait attributed to pelvic muscle imbalance was reported.  

At the MEB examinations (documented on DD forms 2807-1 and 2808) dated 9 November 2004 (5 months before separation), the CI reported that pain of the left leg and right pelvis inhibits ambulation and sitting.  The physical examination showed “decreased” range of motion (ROM) of the spine “secondary to the pelvic fracture.”  Ranges of motion obtained at a physical therapy (PT) visit in November 2004 showed flexion of 90 degrees (normal 90), extension of 25 degrees (normal 30), and normal lateral flexion and rotation bilaterally.  

At a 13 December 2005 VA Compensation and Pension (C&P) examination, performed 8 months after separation, the CI reported undergoing right lower extremity hardware removal 4 days prior and denied any incapacitating episodes due to back pain.  The physical examination showed use of crutches and a wheelchair, therefore the gait could not be assessed.  There was tenderness of the distal spine and over the sacrum with a palpable sacral bony deformity.  ROM measurements showed a flexion of 90 degrees, with normal extension, side bending and lateral rotation.  There was no pain or changes in ROM measurements noted during and after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the back pain at 10% for “back pain as residual post pelvic and sacral injuries and fractures,” coded 5237 (lumbosacral strain).  The VA rated the condition at 0% for “residuals of fractured pelvis, right femur, right tibia, left clavicle, broken ribs, tail bone, and traumatic brain injury,” coded 8045 (residuals of traumatic brain injury).  

The Board agreed that a 10% rating, but no higher, was justified for limitation motion with combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the MEB examination proximate to separation.  There was documentation of assisted ambulation both before and after separation; however, the MEB examination stated that pain in the left leg and the right pelvis interfered with sitting and ambulation; while the December VA C&P examination documented assisted ambulation due to right lower extremity hardware removal.  The November 2004 PT examination and the December 2005 VA C&P examination documented full ROM without pain.  There was no documentation of muscle spasm or guarding attributable to the back condition severe enough to result in an abnormal gait in support of a higher rating.  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 low back pain condition.  

Contended PEB Conditions.

Right Common Peroneal Mononeuropathy.  The CI’s MVA resulted in a right lower extremity femoral and tibial fracture.  Decreased sensation of the dorsal foot, and weakened dorsiflexion of the great toe and ankle was documented after the accident and during the inpatient stay in December 2003.  Electrophysiologic testing was obtained in March 2004 and documented a right common peroneal mononeuropathy.  At the time of the MEB NARSUM (July 2004), the CI reportedly had absent sensation in the dorsum of the right foot with 4/5 strength (normal 5/5) of great toe extension (dorsal flexion).  

Right Femoral Fracture and Right Tibial Fracture.  As an immediate result of the December 2003 MVA, the CI underwent intramedullary nailing (rod through the center of the bones) of the right femur and tibia.  The external femoral hardware was removed and the intramedullary rod was replaced in February 2004 for better alignment.  On follow up 6 weeks later (March 2004), the physical examination showed knee range of motion to be 0-100 degrees (normal 0-140) with “intact” motor function.  At the time of the MEB NARSUM in July 2004, the CI was reportedly bearing full weight during ambulation with a walker for community distances and at home sometimes without a walker.  She had a “functional” leg length discrepancy on the right with 5/5 strength of bilateral knee extension and flexion.  Radiographs (X-ray) studies in November 2004 and March 2005 showed normal alignment of the knee and ankle.  The orthopedic examiner stated that March 2005 X-rays of the femur showed intact hardware and that it was “well aligned.”  

Left Clavicular Fracture.  As an immediate result of the December 2003 MVA, there was a mid-shaft clavicular fracture.  X-ray studies in January 2004 (4 weeks later) showed a visible fracture.  On follow up in March 2004 (1 year before separation), the orthopedic examiner documented tenderness and mild deformity.  There was no further documentation regarding the clavicle fracture in the year prior to separation.  

The Board’s main charge is to assess the fairness of the PEB’s determination that the right common peroneal mononeuropathy, right femoral fracture, right tibial fracture, and left clavicular fracture were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

All of the conditions were profiled as “multiple fractures.”  None of the contended conditions were specifically implicated in the commander’s statement, but could be inferred from his comments which referred to her “current medical condition” as inhibiting driving, climbing, carrying and installing pipelines and requiring “exceptional physical stamina and upper body strength.”  All of the contended conditions were not judged to fail retention standards.  There was no performance based evidence from the record that any of these contended 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 the any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right femoral and right tibial fracture, left clavicular fracture, and right common peroneal mononeuropathy 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, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
, AR20160017816  (PD201404099)

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