RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02318
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E4, Bridge Crewmember, medically separated for a “crushed pelvis…sustaining multiple pelvic fractures,” with a disability rating of 10%.

CI CONTENTION:  The CI contends for her pelvic, low back and hip injuries.  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:  

SERVICE PEB - 20051213	VARD - 20060920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crushed Pelvis…	5099-5003	10%	Crush Injury, Pelvic Ring…	5236	20%	20060609	
			Ruptured Colon	7329	20%	20060609	
Low Back Pain	Not Unfitting	Scar… Thoracic Area & Left Buttock	7801	20%	20060609	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Crushed Pelvis.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a crushed pelvis on 15 July 2004, after a boulder rolled over onto her pelvis during annual training.  

The 28 July 2005 orthopedic MEB consultation, 6 months prior to separation, documented the CI’s report of pelvic pain with intensity of 3/10.  The CI reported she was able to walk 1/2 mile without substantial exacerbation of her pain.  She also reported low back pain from standing for more than 15-20 minutes.  She noted that she had normal bowel function and no numbness or tingling below the waist.  Physical examination showed an abnormal gait, slightly elevated hip on the right, and a well-healed skin graft.  The CI had a normal sensory examination.  The examiner noted that the CI’s condition was stable but that she would have long-term pain and disability.  During the 16 August 2005 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported she had difficulty with her lower extremities since her injury.  Physical exam showed full range of motion (ROM) of lumbar and cervical spine and an antalgic gait.  Hip ROM was recorded as left hip flexion at 75 degrees (normal 125) and abduction to 30 degrees (normal 45).  Right hip flexion was 83 degrees and abduction 20 degrees.  The CI had normal motor strength in bilateral lower extremity and no evidence of neurological or vascular compromise.  The MEB NARSUM examination on 6 September 2005, 4 months prior to separation, noted complaint of chronic pelvic pain.  The CI took narcotic medication for her pain on as needed basis.  ROM showed right hip flexion to 119 degrees, extension to 15 degrees, and abduction to 34 degrees.  Left hip ROM recorded flexion to 101 degrees limited by pain, extension to 17 degrees (normal 30), and abduction to 46 degrees.  Painful motion was present in all ROM.  The examiner noted the CI’s pain was constant and was usually at an intensity of 2/10 but rose to 7/10 when exacerbated by prolonged walking, climbing stairs, walking on uneven ground and rucking.  Her condition was noted as stable.

At the June 2006 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported continued pelvic pain with no relief from over-the-counter pain medication (ibuprofen).  She also reported an unsteady gait, but made no mention of falls or weakness.      Physical exam showed a limp favoring her left side, and her left side was lower than her right side.  ROM recorded “complete ROM of her lumbosacral spine with pain reported at all end points.”  The examiner noted a 0.5 inch length difference in her legs, with the right being longer than the left.  Muscle atrophy of the lower extremities was absent and strength was intact.  Right hip ROM recorded flexion to 120 degrees, extension to 15 degrees, and abduction to 30 degrees.  Left hip ROM documented flexion of 100 degrees, extension to 15 degrees and abduction to 20 degrees.  Painful motion was not recorded.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the crushed pelvis condition at 10%, coded analogously 5099-5003 (arthritis, degenerative), and cited slight and frequent pain.  The VA rated the condition of crush injury at 20%, coded 5236 (sacroiliac injury and weakness), citing, “while range of motion is normal except for endpoints, there is abnormal gait and absence of the lordotic curve, as well as pain which radiates from the pelvis into the lower extremities and results in functional loss.”

The higher rating of 20% under the 5003 code requires radiographic evidence of involvement of 2 or more major or minor joint groups, with occasional incapacitating exacerbations.  The panel noted the threshold was clearly met for radiographic evidence; however, evidence of incapacitating exacerbation was absent.  The panel was unable to locate any documentation of medical prescription related to the order of quarters, bedrest, etc.  Therefore, there was no justification for a higher rating under the 5003 code.  Although there was documented shortening of the lower extremity, the degree of shortening was not compensable under the 5275 code (bones, of the lower extremity, shortening of).  The panel found no path to a higher rating under any applicable code.  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 crushed pelvis condition.  

Contended PEB Conditions:  Lower extremity weakness secondary to pelvic pain, low back pain secondary to pelvic fractures.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of these conditions was profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the crushed pelvis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended lower extremity weakness secondary to pelvic pain and low back pain secondary to pelvic fractures, the panel recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150729, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012483, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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