RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02239
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20050716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Helicopter Airframe Mechanic, medically separated for “left ischial tuberosity avulsion fracture” with a disability rating of 10%.

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 - 20050511	VARD - 20050823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ischial Tuberosity Avulsion Fracture	5099-5003	10%	Residuals, S/P Avulsion Fracture of the Ischium	5313-5252	10%	20050607	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Ischial Tuberosity Avulsion Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a pre-enlistment left hamstring injury (high school track) and reported an onset of left hamstring pain with running in 2004.  Imaging (X-ray and MRI) demonstrated a “large” avulsion fracture off the left ischial tuberosity (the hamstring muscle attachment) of chronic appearance.  There was confirmation of a normal gait and normal hamstring strength in clinical STR entries; but, there was no evidence specifically directed at range of motion (ROM) or other VASRD-ratable findings. An orthopedic consultant opined that surgery was not indicated because of the chronicity with “minimal symptoms except with athletic activity and long periods of being seated.”

The 1 April 2005 MEB NARSUM examination, 4 months before separation, documented nonspecific pain that prohibited running, other rigorous military requirements, and limited prolonged walking or standing.  Physical examination recorded a normal gait, normal hamstring strength, and “tenderness at the area of the avulsion.”  There was no documentation of ROM or other findings.

A 7 June 2005 VA Compensation and Pension (C&P) examination, 1 month  before separation, documented nonspecific pain that prohibited running and limited prolonged walking or standing.  Physical examination recorded normal gait, strength, and neurological findings.  There was no documentation of specific joint, extremity findings or ROM.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ischial tuberosity avulsion fracture 10%, analogously coded 5099-5003 (degenerative arthritis).  The VA also rated the left ischial tuberosity avulsion 10%, analogously coded 5313-5252 (Group XIII muscle disability rated for limitation of thigh flexion), based on C&P examination 1 month before separation, citing a remaining fracture and tenderness.

The VA code 5313 is accurate for hamstring muscle disability; but, members agreed that the functional impairment in evidence (especially as expressed in the STR surgical opinion) could not be reasonably characterized as more than “moderate” disability, the 10% criterion of code 5313.  Likewise considered was analogous application of code 5255 (femur, impairment) which provides ratings for contiguous hip disability, and would confer a 20% rating for “moderate” disability.  Members agreed, however, that analogous application of this fracture code was not sufficiently justified by VASRD §4.20 (analogous ratings), expressly noting that the muscle code was distinctly more specific for the pathology and disability if alternative analogous rating was indicated.  There was no evidence for ROM limitation or any other ratable criterion that would justify a rating higher than 10% under any other applicable code available in VASRD §4.71a.  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 of the left ischial tuberosity avulsion fracture.

BOARD FINDINGS:  In the matter of the left ischial tuberosity avulsion fracture and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150820, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
				XXXXXXXXXXXXXXXXXX