RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01484
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Multichannel Transmission Systems Operator- Maintainer, medically separated for “chronic pelvic pain…secondary to a stress fracture…” with a disability rating of 0%. 

CI CONTENTION:  The CI contends that she still has pain due to her injury after being separated for more than 9 years.  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:  

IPEB - Dated 20051206	No VA Records Available*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pelvic Pain…	5099-5003	0%	No VA Placement	
RATING:  0%	No VA RATING	
*VA documents were requested and the VA stated no VARD was requested or conducted.

ANALYSIS SUMMARY:  

Chronic Pelvic Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had left anterior pelvic pain beginning in April 2004.  Evaluations documented a stress fracture of her left pubic ramus (pelvis) and pelvic/hip pain persisted.  An MRI in March 2005 noted a minimally displaced healing left inferior pubic ramus fracture.  Follow-up X-rays documented a healed fracture.  At the MEB examination, the CI reported constant 5/10 pelvic pain that increased to 8/10 with activities or standing.  The MEB physical examination noted tenderness in the left inferior inguinal area and “increased tenderness” with left hip external rotation.  Range of motion (ROM) was full in both hips with no neurovascular deficits noted.  Physical therapy (PT) documented formal goniometric active ROMs with pain-limited left hip flexion to 95 degrees (opposite side 120; normal 125) as well as pain-limited abduction and adduction (NOTE:  Passive left hip ROMs approximated those of the right hip and normal VASRD hip ROM values).  Records and the earlier NARSUM addendum had documented normal heel-toe gait.  The diagnosis was chronic pain status post pubic ramus stress fracture.  There were no VA examinations or ratings in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the pelvic pain condition at 0% analogous to 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]) and there was no record of VA rating.  It was considered likely that the PEB applied AR 635-50 (rating on mechanical loss of motion only) based on the PT active ROM findings, or did not apply VASRD §4.59 (painful motion).  The Board considered and discussed VASRD §4.67 (pelvic bones) for rating the CI’s condition.  Given the pain-limited left hip PT ROMs and the NARSUM note of  increased discomfort on hip motion, the Board agreed that there was adequate objective evidence for a 10% rating IAW VASRD §4.59 (painful motion).  The PT ROMs would also warrant a 10% rating under 5003 criteria for objective evidence of pain-limited motion.  Analogous rating as neuritis under the ilioinguinal nerve (8799-8730) on the left side (pain in that nerve area) would not provide any higher rating and there was no muscle injury, pelvic/abdominal surgery, or hernia for alternative higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the pelvic pain (secondary to pelvic stress fracture) condition.  

BOARD FINDINGS:  In the matter of the chronic pelvic pain (secondary to pelvic stress fracture, with painful left hip motion) condition, the Board unanimously recommends a disability rating of 10%, 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pelvic Pain (Secondary to Pelvic Stress Fracture, with Painful Left Hip Motion)	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX AR20160014801 (PD201501484)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA