RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01060
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “chronic pain secondary to pelvic stress fractures,” 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 - 20050528	VARD - 20040202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Secondary to Pelvic Stress Fractures	5099-5003	10%	Right Hip Tendonitis	5299-5024	NSC	STR	
			Pelvic Stress Fracture	5299-5250			
			Lower Extremities Numbness	8520			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Pain Secondary to Pelvic Stress Fractures.    According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “chronic pain secondary to pelvic stress fractures” condition began without a history of trauma in December 1997.  The MEB forwarded “chronic pelvic stress fractures with possible osteitis pubis” for PEB adjudication.  Orthopedic examination and radiographic studies performed in January 1999 resulted in a diagnosis of bilateral left greater than right pubic rami stress fractures.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2001, 7 months prior to separation, the CI reported “fractured my pelvis while running in PT.”  Physical examination annotated chronic stress fractures of the pelvis.  The MEB NARSUM examination on 23 April 2002, 3 months prior to separation, noted complaints of bilateral hip pain.  The pain was described as activity and dull and aching in nature.  The pain was relieved by rest and nonsteroidal anti-inflammatory medications.  Physical examination showed tenderness to palpation upon compression of bilateral pubic rami and pubic symphysis.  There was not any tenderness to palpation of the greater trochanters (sides of the hips) and no evidence of hip flexure contraction.  The hip range of motion was noted anterior rotation (flexion) to 70 degrees (normal 125) and external rotation to 50 degrees.  The CI demonstrated no pain with maximal internal rotation of bilateral hips.  There was mild rectus femoris (quadriceps) tightness.  

The CI failed to report for the VA Compensation and Pension (C&P) evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic pain secondary to pelvic stress fractures” condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA did not service connect the right hip tendonitis coded 5299-5024 (analogous to tenosynovitis), pelvic stress fracture coded 5299-5250 (analogous to hip, ankyloses of), or lower extremities numbness coded 8520 (Paralysis) conditions based on the service treatment records and failure to show for the scheduled VA C&P examination.  The Board noted reports of pelvic pain with use, radiographic evidence of healed stress fractures and degenerative changes, and physical findings of tenderness to palpation.  The Board noted bilateral hip limitation of motion resulting from the bilateral pelvic stress fractures.  The Board found each hip separately unfitting with identical ratings.  Board members agreed that each hip met criteria for a 10% rating for painful motion IAW § 4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for each hip  for chronic pain secondary to pelvic stress fractures” condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the bilateral chronic pain secondary to pelvic stress fractures, the Board unanimously recommends a disability rating of 10% for the left hip and 10% for the right hip, both coded 5099-5003  IAW VASRD §4.71a.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Chronic Pain Secondary to Pelvic Stress Fractures	Right	5099-5003	10%	
	Left	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011796, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure