RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01519
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Healthcare Specialist, medically separated for “chronic pain secondary to left inferior pubic ramus stress fracture” with a disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  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 - 20061027	VARD - 20070817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain….Left Inferior Pubic Ramus Stress Fracture	5099-5003	10%	Inferior Pubic Stress Fracture, Left	5299-5252	0%	20070419	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Pain….Left Inferior Pubic Ramus Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain condition began during basic training without specific injury or trauma.  Diagnostic imaging showed a healing left inferior pubic rami stress fracture with no abnormality of the femur.

At the 13 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported left leg, back and pelvic pain.  Physical examination showed tenderness to the left inguinal area with slight (4/5) weakness.  Goniometric range of motion (ROM) was flexion to 70 degrees (normal 125), extension to 25 degrees (normal 20), external rotation to 45 degrees (normal 45), and abduction to 25 degrees; painful motion was not addressed.

The 13 September 2006 MEB NARSUM examination, 2 months before separation, noted complaints of left groin pain.  Physical examination showed a slightly antalgic gait favoring the left lower extremity and use of crutches for assistance with ambulation.  There was a positive Faber’s test (pain on hip flexion, abduction and external rotation) with increased symptoms with left straight leg raise.  Passive ROM was limited and painful.

At the 19 April 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported lower pelvic pain traveling into the lower back which was worsened with activity or stress.  Physical examination showed normal posture and gait.  The left hip showed no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement, subluxation or guarding of movement.  ROM was flexion to 125 degrees, extension to 30 degrees, external rotation to 60 degrees, and abduction to 45 degrees without painful motion.  Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left inferior pubic ramus stress fracture condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing pain-limited motion rated as slight not requiring daily narcotics.  The VA rated the left inferior pubic ramus stress fracture condition 0%, analogously coded 5299-5252 (thigh, limitation of flexion), based on the C&P examination 5 months after separation, citing no pain limitations with symmetric bilateral hip motion.

Regarding the left pubic ramus stress fracture condition, the panel considered VASRD §4.67 (pelvic bones); there were no residuals of faulty posture, painful lumbar spine motion, spine tenderness, sciatic neuritis or peripheral nerve injury.  The panel therefore considered if the limitation of left hip motion (flexion) was compensable.  There was no compensable limitation of hip motion under codes 5250 thru 5253.  However, there was clear objective evidence of painful motion documented by the MEB NARSUM examination, most proximate to separation, causing functional loss (based on §4.59, §4.40 and §4.45) to support a 10% rating.  Additionally, analogous code 5255 (femur, impairment of) for slight hip disability at 10% is supported by the evidence.  IAW VASRD §4.14 (avoidance of pyramiding) neither of the aforementioned pain-related 10% rating options benefit the CI over the analogous 5003 10% rating adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left inferior pubic ramus stress fracture condition.

BOARD FINDINGS:  In the matter of the left inferior pubic ramus stress fracture condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009056, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure