RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00587
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “left inferior pubic ramus stress fracture…” (pelvic condition) with a disability rating of 0%.  

CI CONTENTION:  “Consider 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 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 – 20050909	VARD - 20060302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Inferior Pubic Ramus Stress Fracture	5099-5003	0%	Residuals Of Stress Fracture claimed as Left Inferior
Pubic Ramus Stress	5099-5003	NSC	20060208	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Pubic Ramus Stress Fracture Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought medical attention for left hip/groin pain during the second week of basic training.  Left hip, femur, and pelvis X-rays were normal.  An 8 April 2005 diagnostic imaging (bone scan) study showed a left inferior pubic ramus stress fracture (repetitive stress induced fracture).  A 6 July 2005 pelvis X-ray showed a left inferior pubic ramus periosteal reaction that could be related to a healing stress fracture.  A 6 July 2005 physical therapy (PT) examination documented full active hip range of motion (ROM) with no pain.  The 18 August 2005 NARSUM, 6 weeks before separation, recounted the history and interventions.  The CI reported that left hip/groin pain began during the second week of basic training with no trauma.  The CI did not experience significant improvement with activity modification, crutches, PT, convalescent leave, and nonsteroidal anti-inflammatory drugs (NSAIDs).  He complained of left hip pain that was 1/10 at rest, and 3/10 with prolonged physical activity.  The focused physical examination documented an antalgic (assuming a gait or posture to lessen pain) gait.  The musculoskeletal examination revealed localized left inferior pubic ramus tenderness.  There was normal full ROM.  The Patrick (assesses hip and sacroiliac joint pathology) test was positive and the straight leg raise ([SLR] assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy), log roll test (assesses for hip joint pathology), and heel tap (assess for fracture or joint pathology) tests were negative.  Strength and sensation were intact.  The examiner recounted the findings of the X-rays and bone scan.  The diagnosis listed left inferior pubic ramus stress fracture.  An 8 February 2006 pelvis X-ray was normal.  In the 8 February 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported a history of a left inferior pubic rami stress fracture.  He denied pain or any symptoms as a result of the condition.  The CI reported no required bed rest, no time lost from work, and no functional impairment.  The examiner documented “The veteran refuses a full physical examination.  He states that the VA did not need to have that information.  He signed a note stating that ‘I refuse entire examination except for pelvic and hip examination.’ Therefore, examination is limited to that portion of the body.”  The physical examination documented a normal posture and gait.  The pelvic bone examination was normal and revealed no dislocation, malunion, or nonunion.  The bilateral hip examination was normal and revealed no redness, heat, effusion (fluid collection), drainage, instability, weakness, or tenderness.  Bilateral hip ROM was flexion of 125 (125 normal), extension of 30 (30), adduction of 25 (25), abduction of 45 (45), external rotation of 60 (60), and internal rotation of 40 (40) degrees.  Hip ROM was not limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  Under diagnosis the examiner documented “For the veteran's claimed condition of left inferior pubic rami stress fracture, I am really unable to render a diagnosis.  ER is stating that he has normal examination and physical findings in that his effect did exhibit by bone scan.  I have seen reports and it appears to have resolved in that he has full range of motion of hips and is asymptomatic.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing left inferior pubic ramus stress fracture by X-rays and bone scan and rated for slight, intermittent, pain.  The VA did not service-connect the stress fracture under an analogous 5003 code (arthritis, degenerative) based on the VA C&P examination 4 months after separation, citing no objective evidence to diagnosis a chronic condition.  There was no compensable limitation of motion for consideration under 5251 (thigh, limitation of extension of) or 5252 (thigh, limitation of flexion of).  There was no evidence of disability for consideration under 5250 (hip, ankylosis of), 5253 (thigh impairment of abduction, adduction, rotation of), 5254 (hip, flail joint), or 5255 (femur, impairment of).  Board members agreed a 10% rating was not justified IAW §4.40 (functional loss) and §4.59 (painful motion).  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 pubic ramus stress fracture condition.  

BOARD FINDINGS:  In the matter of the pubic ramus 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.  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 20150604, w/atchs
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000270 (PD201500587)

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