RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01495
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “right posterior pubic ramus stress fracture,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20041115	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Posterior Pubic Ramus Stress Fracture	5099-5003	0%	No VA Entry	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Posterior Pubic Ramus Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right groin pain condition began on 28 July 2004 after she slipped and fell on the obstacle course and landed astraddle on a log.  She sustained a pelvic contusion and was treated with Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID).  X-rays dated 6 August 2004 of the pelvis revealed a right inferior pubic ramus stress fracture on the medial aspect with no displacement.   Treatment was modified to include Percocet (oxycodone, a narcotic and acetaminophen, a pain reliever), Motrin, crutches, profile, convalescent leave, and referral to physical therapy.  X-rays on 26 September 2004 demonstrated a healing fracture of the right inferior pubic ramus.   Despite physical therapy rehabilitation for several weeks after convalescent leave, the CI reported increased pain at the fracture site particularly with stair climbing.  X-rays dated 12 October 2004 demonstrated healing of the right inferior pubic stress fracture. 

During the 2 November 2004 the MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported a stress fracture in the pelvis.  

The 2 November 2004 MEB NARSUM examination, 1 month prior to separation, noted complaints of right groin pain, which persisted at a severity of 3/10 (10 being the worst pain) and up to 6/10 with physical activity to include fast pace walking and climbing stairs.  Examination revealed an antalgic gait.  There was localized tenderness to the right inferior pubic ramus.  She had a full range of motion (ROM) compared to the left side.  A heel tap and logroll tests were negative.  Strength of the lower extremity muscles was 5/5.  There was no swelling and no edema and she was neurovascularly intact.  X-rays on 12 October 2004 showed healing of the right inferior pubic ramus stress fracture.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right posterior pubic ramus stress fracture condition 0%, coded 5099-5003 (Arthritis, degenerative), citing X-ray evidence.  X-rays demonstrated healing of the stress fracture prior to discharge; however, in the absence of hip ankylosis (code 5250), limitation of flexion or extension (code 5251 or 5252), thigh impairment (code 5253), or hip, flail joint (code 5254), there was no route to a higher rating.  Members considered a rating of 10% using an analogous code for femur impairment (code 5255) for the slight hip disability manifested by an antalgic gait and localized tenderness to the right inferior pubic ramus; however, the site of injury was a pelvic stress fracture rather than a femur fracture, but because of her functional limitation of her right hip at the time of separation, members felt that a 10% rating would not be unreasonable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the right posterior pubic ramus stress fracture condition, coded 5299-5255.  

BOARD FINDINGS:  In the matter of the right posterior pubic ramus stress fracture condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent did not elect to submit a minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Right Posterior Pubic Ramus Stress Fracture	5299-5255	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record

AR20170008519, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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