RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00543
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “sacroiliac dysfunction causing low back and [left] hip pain,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 on 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 - 20090601	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sacroiliac Dysfunction causing Low Back and [Left] Hip Pain	5236	10%	No VA Disability Claim Filed	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY: 

Sacroiliac Dysfunction causing Low Back and [Left] Hip Pain.  The PEB combined the back and left hip conditions as a single unfitting condition coded 5236, sacroiliac injury and weakness, and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the Disability Evaluation System or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the back and hip conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in August 2008 while in basic training.  The hip condition began in January 2009 at advanced individual training.  Neither was associated with trauma.  X-rays of the hips and pelvis on 27 February 2009 were normal.  A whole body bone scan on 11 March 2009 was also normal without any etiology for the CI’s back or hip pain shown.  X-rays of the lower back on 5 May 2009 were also normal.  Despite treatment, the back and left hip conditions could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic low back pain without radiculopathy due to persistent strain,” and “left hip pain secondary to ilio-femoral ligament strain” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2009, a month prior to separation, the CI reported constant upper and lower back associated with sharp pain and numbness in the right leg.  The physical examination was “grossly intact.”  The MEB NARSUM examination on 5 May 2009, a month prior to separation, noted complaints of back pain without radicular symptoms, changes to bowel or bladder habits, and left hip pain without any instability or radiculopathy.  Physical examination of the low back revealed a slight antalgic gait due to pain favoring the right hip.  There was spinal tenderness noted during the back range of motion (ROM) examination.  One maneuver not expected to produce pain was positive (lumbar pain with an axial load).  The neurological examination was normal as was the full-goniometric ROM of the lumbosacral spine.  Neither painful motion nor spasm were recorded.  Physical examination of the left hip showed ilio-femoral ligament (between the pelvis the thigh bone) and hip bone tenderness.  The left hip goniometric-ROM showed flexion 110 degrees (normal 125); extension to 10 degrees (normal 20); and abduction to 45 degrees (normal).  The CI could cross her legs and out-toe over 15 degrees.  Painful motion was not recorded.  Magnetic resonance imaging of the lumbosacral spine on 8 May 2009 was normal.  

The CI did not file a VA disability claim; and therefore, there was no VA Compensation and Pension evaluation for Board review.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the sacroiliac dysfunction causing low back and left hip pain 10%, coded 5236 (sacroiliac injury), citing painful motion.  There was no VA rating.  The Board first considered if the low back and left hip pain, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  The Board noted that both the low back pain and left hip conditions were implicated by the commander’s statement and were permanently profiled L3.  However, the Board consensus determined that the evidence at separation was not sufficient to overcome the PEB adjudication that the combined, rather than separate, hip and back pain conditions were unfitting.

The Board then considered the rating recommendation for the combined low back and hip pain condition at the time of separation.  Regarding the back, it noted that the there was no limitation in motion of the back, painful motion, or incapacitation to support a compensable rating.  Muscle tenderness, spasm, and guarding were absent. Tenderness of the spinous processes was present for basically the entire thoracolumbar spine and S1, but X-rays and a bone scan were normal.  One test for non-organic pain was positive.  Regarding the hip, the ROM of the hips was non-compensable and nearly identical bilaterally.  Painful motion of the hip was not clearly recorded. Although a slight antalgic gait favoring the right hip was documented, it was not attributed specifically to either the back or hip and it was also noted that the CI could rise on her heels and toes without difficulty.  The Board found no route to a combined rating higher than the 10% adjudicated by the PEB.  Thus, no rating advantage is provided to the CI.  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 sacroiliac dysfunction causing low back and [left] hip pain condition.

BOARD FINDINGS:  In the matter of the sacroiliac dysfunction causing low back and hip pain 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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018749  (PD201500543)

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