RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX                                                              CASE:  PD-2015-00157 
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fleet Cryptologic Systems Maintenance Technician, medically separated for “crush injury, pelvis,” with a disability rating of 10%.  

CI CONTENTION:  The CI stated he was given a higher rating for his conditions by the VA.  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 - 20040226	VARD - 20050607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crush Injury, Pelvis	5236	10%	Lumbar Sacroiliac Strain	5242	20%	20050107	
			Status Post Compression/Pelvic Fracture with Residual Pain and Limited ROM of Right Hip	5252	10%	20050107	
			Radiculopathy and Paresthesias, Right Lower Extremity Associated with Lumbar Strain	8520	10%	20050107	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Crush Injury, Pelvis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s initial injury occurred in August 2002 when he was caught between a ship and a paint barge.  He had complaints of back pain and right lower extremity weakness, paresthesias and pain.  Diagnostic imaging showed a nondisplaced lateral compression type fracture of the pelvis (stable).  Lumbar magnetic resonance imaging (MRI) studies on 1 September 2002 were essentially normal.  On 1 May 2003, the CI fell down some stairs and noted increasing pain in the low back and pelvis on the right side.  MRI studies on 18 June 2003 showed mild disc desiccation at L4-5 and L5-S1 with mild disc bulges, but no significant canal or neural foraminal narrowing and no acute changes to the sacroiliac (SI) joints.  Rheumatology and additional evaluations found no evidence of systemic diseases of the joints (ankylosing spondylitis or connective tissue diseases).  

At the Fracture/Trauma clinic appointment on 30 July 2003, the CI reported continued hip pain with mild tingling in the right toes.  X-rays showed SI joint auto fusing in the past.  Examination showed tenderness to the back, SI joints and hips (right>left).  Provocative tests for radicular symptoms (SLR) was negative.  Muscle strength was normal, sensation was intact to light touch, and reflexes were equal bilaterally.  At the Fracture/Trauma clinic appointment on 17 September 2003, the CI reported chronic hip and back pain.  His activity level was decreased due to pain and fatigue.  The CI reported nerve radio-ablation done in July had helped for a little while, but the pain was coming back.  Pain was recorded as 5/10 and sleep was noted to be affected due to pain.  Examination showed painful bilateral hip range of motion (ROM) as summarized in the chart below.  EMG (electromyography) performed in October 2003 was normal.  

There was no surgical indication.  Despite treatment, the pelvic crush injury condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty, and following multiple Limited Duty Boards, the CI was referred for MEB.  The MEB forwarded “crush injury, pelvis” for PEB adjudication.  

The MEB NARSUM dated 16 November 2003, 9 months prior to separation, noted continued complaints of hip and back pain rated 8/10 with easy fatiguing and summarized prior evaluations.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated January 2004, 7 months prior to separation, the CI reported chronic extreme back pain with constant tingling in the right leg that sometimes went numb and immobile.  He reported numbness and tingling of the right foot and his legs not being as mobile since his pelvic crush injury.  He related repeatedly being given SIQ (sick in quarters) and missing duty for the entire month of May 2003.  Examination indicated “pelvic, back, right leg pain s/p (following) crushing injury in 2002.”  The CI was being treated for back pain and bilateral hip pain by a chiropractor with examination findings of bilateral painful hip motion and limited back ROM as charted below.  

At the 7 January 2005 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported severe pain in the low back with radiation of pain to the right lower extremity described as numbness and tingling.  The CI reported a pelvic bone fracture, constant right hip pain and that he walked with a limp.  Physical examination noted the CI was using a cane, but there was no evidence of a limp, and gait was not unsteady or unpredictable.  The CI had mild difficulty getting on and off the exam table secondary to low back pain.  There was paraspinal muscle spasms at L3-4, L4-5 and L5-S1 without back weakness or tenderness.  Straight leg raise testing (SLR) for radicular signs was positive on the right and negative on the left.  There was no evidence of radiation of pain.  Motor strength and reflexes were normal.  There was decreased sensation in the right lower leg and foot.  There was painful limited motion of the back and right hip as charted below.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	Chiro ~5 Mos. Pre-Sep	Chiro ~3 Mos. Pre-Sep	Chiro ~1 Mos. Pre-Sep	VA ~5 Mos. Post-Sep	
Flexion (90 Normal)	30	65	55	55	
Combined (240)	110	185	175	175	
Comments				Painful motion; spasm; + R. SLR 	
§4.71a Rating	40%	10%	20%	20%	

Right Hip (Thigh) ROM
(Degrees)	Clinic ~11 Mos. Pre-Sep	VA C&P ~5 Mos. Post-Sep	
Flexion (125 Normal)	130	90	
Extension (20)	-	30	
External Rotation (45)	40	50	
Abduction (0-45)	40	30	
Adduction (45)	-	25	
Comment	Painful motion (bilaterally)	Painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the pelvic crush injury condition 10%, coded 5236 (sacroiliac injury and weakness).  The VA rated the compression/pelvic fracture condition and residuals using three ratings:  the lumbar sacroiliac strain condition at 20%, coded 5242 (degenerative arthritis of the spine); residual right hip pain and limited ROM at 10%, coded 5252 (thigh, limitation of flexion of); and associated right lower extremity radiculopathy and paresthesias at 10%, coded 8520 (sciatic nerve, mild paralysis of); all based on the VA C&P examination 5 months after separation, citing painful limitation of motion and mild incomplete paralysis.  

The Board considered the tenants of VASRD §4.67 (pelvic bones) and §4.66 (sacroiliac joint) as well as the fitness implications of the residuals due to the pelvic crush injury (compression/pelvic fracture).  The Board discussed the CI’s symptoms and residuals from the pelvic crush injury and the fitness implications and various coding and rating options.  The preponderant disabilities were of the back/SI joint and the right hip/leg components.  

The CI’s back pain and limited back ROM was adjudged as due to the pelvic crush injury and was duty limiting, unfitting, and compensable.  The Board agreed that a 20% rating, but no higher, was justified for limitation of thoracolumbar flexion (greater than 30 degrees but not greater than 60 degrees) reported on the chiropractic and VA examinations most proximate to separation.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  

The Board deliberated if the impairment from the painful right hip motion and/or the right leg paresthesias as a result of the CI’s pelvic crush injury were duty limiting, unfitting, and compensable (see VA ratings) or were subsumed under the overall rating for the SI joint/thoracolumbar rating.  Although the general spine rating criteria states that the spine (or SI joint rating) is “with or without symptoms such as pain (whether or not it radiates),” the Board consensus was that the CI’s painful and painful limited right hip motion was considered a separate impairment (with due consideration of VASRD §4.14 [avoidance of pyramiding]) due to crushing of the pelvic structures related to hip/thigh motion and not due to the SI joint or radiating pain from a spine condition.  The CI’s right hip pain limited motion (including right leg limitations) was adjudged, by Board consensus, as duty limiting, unfitting, and compensable.  

There was not sufficient limitation of right hip/leg motion to support a minimum rating under the specific hip and thigh codes for limitation of motion; however, there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  Coding analogous to 5253 (thigh impairment) was considered predominate.  There was no indication that the right lower leg sensory deficit rose to the level of being unfitting, and the Board adjudged that no additional rating could be awarded on that basis.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the pelvic crush injury condition, coded 5236, and the Board majority recommends the addition of a 10% rating coded 5299-5253 (right thigh/hip).  

BOARD FINDINGS:  In the matter of the pelvic crush injury condition, the Board unanimously recommends a disability rating of 20%, coded 5236 IAW VASRD §4.71a; the Board majority recommends an additional disability rating of 10% coded 5299-5253 IAW VASRD §4.71a.  The single voter for dissent did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Crush Injury, Pelvis	5236	20%	
	5299-5253	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150210, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, retroactive placement on the Temporary Disability Retired List with a 50 percent disability rating for six months, followed by a final disability rating of 10 percent. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 60 percent disability rating (increased from 10 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     e. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).   

     f. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).  

     g. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 0 percent).

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.     

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)