RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01719
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Basic Trainee, medically separated for “bilateral hip and groin pain secondary to bilateral inferior pubic ramus and left superior ramus stress fracture with a disability rating of 0%.  

CI CONTENTION:  Still has problems with the injury.  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 - 20050502	VARD - 20070314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip and Groin Pain	5099-5003	0%	Residual Stress Fracture, Bilateral Hip	5099-5015	0%	20061129	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Pubic Ramus Stress Fractures.  The PEB combined the bilateral hip and groin pain conditions as a single unfitting condition analogously coded 5099-5003 and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral hip and groin conditions are presented, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain began in February 2005 after 3 weeks of basic training.  Radiographic evaluations (bone scan) in March 2005 documented left superior and bilateral inferior pubic ramus stress fractures.  At an 11 April 2005 physical therapy (PT) visit, 1 month prior to separation, the examiner documented an antalgic gait and found painful motion of both hips during flexion, abduction, and “at the extreme limits of the ROM” with internal and external rotation.  There was also immediate onset of pain with squatting.  During the 13 April 2005 MEB examination (recorded on DD Forms 2697 and 2808), the CI reported decreased range of motion (ROM) and inability to run, jump, march, or stand for prolonged periods.  The physical examination showed painful and limited ROM.  The 19 April 2005 MEB NARSUM examination noted use of crutches for ambulation and complaints of bilateral groin pain (left more than right) that increased with physical activity.  The physical examination showed an antalgic gait, inguinal tenderness (left more than right), and painful ROM, that prevented ROM measurements.  There was no VA examination in evidence within the 12-month allowable window for adjudication.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the bilateral hip and groin condition 0%, analogously coded 5099-5003 (degenerative arthritis), with application of Army Regulation 635-40, paragraph B-15.  The panel first considered if the left and right pubic ramus stress fractures, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The bilateral condition was profiled and implicated by the NARSUM examiner.  The bilateral condition was forwarded by the MEB, and the bilateral conditions were considered to fail retention standards by the PEB.  As noted above, there were no distinctions with regards to clinical features or fitness considerations between the right and left hips.  Therefore, it is reasonable to conclude that the effect of both hip conditions reasonably rendered the CI unfit.  The bilateral diagnosis supported a single 5003 based rating for “2 or more major joints” without compensable limitations; thus there is VASRD §4.71a latitude for a bilateral rating.  Members agreed, therefore, that for the evidence did not support recommending separate right and left hip disability ratings.  

The panel next considered the evidence for rating.  Under the provisions of 5003 and IAW §4.71a was warranted as the PT, MEB, and NARSUM examinations provided satisfactory evidence of painful and limited motion of the hips with radiographic evidence of bilateral stress fractures in support of a bilateral 10% rating.  There was no documentation of flexion limited to 30 degrees (5252), nor limitation of abduction beyond 10 degrees (5253) in support of a higher rating that would be of benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a single disability rating of 10% for the right and left hip conditions analogously coded 5099-5003 (degenerative arthritis).  

BOARD FINDINGS:  In the matter of the bilateral pubic ramus stress fracture condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter for dissent recommended modification to 20% and 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	
Bilateral Pubic Ramus Stress Fractures	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150702, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008858 , 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