RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02448
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Structural Maintenance, medically separated for “status post pelvic fracture and sacroiliac joint disruption” 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 - 20051114	VARD - 20060927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Pelvic Fracture and Sacroiliac Joint Disruption, Status Post ORIF…	5299-5236	0%	Tendonitis, Left Hip…Pelvic Fracture with ORIF…	5252	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Status Post Pelvic Fracture and Sacroiliac Joint Disruption (Left Hip).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip condition began in February 2005 after a motor vehicle accident when he sustained pelvic fractures with disruption of the sacroiliac (SI) joint and the pubic symphysis.  On 11 February 2005 the CI underwent open reduction and internal fixation (ORIF) of the pelvic fractures, but not the symphysis pubis, which was high riding relative to the right and rotated.  On 25 February 2005 left hip flexion was 100 degrees (normal 125) and left hip abduction 50 degrees (normal 45).  At a neurosurgical evaluation the CI was noted to have an antalgic gait with the use of crutches due to the pelvic injury.  At physical therapy on 15 April 2005 left hip flexion was 120 degrees.  X-rays of the pelvis on 9 May 2005 revealed a prior left pelvic fracture with internal fixation of the left ilium and flattening of the right femoral head most suggestive of prior/old congenital hip dysplasia.  At an orthopedic evaluation on 9 May 2005 the CI had somewhat of a limp.  Incision sites across the iliac crest on the left side were well healed as was the operative screw site.  Continued physical therapy was recommended.  By 8 June 2005 left hip active range of motion was normal except external rotation at 10 degrees.  On 27 September 2005 the CI complained of pain in his left lower back after he slipped on a wet tile at work and hit his left hip and left posterior pelvic area on the floor.  He had increased pain in his left sacroiliac joint with radiation down the left leg.  On examination he walked with a left limp, had 4/5 muscle strength in the left lower extremity compared to the right, had a negative straight leg test (to determine nerve root irritation), and had pain on palpation of the left sacroiliac joint and left posterior hip, but no tenderness in the sacral or coccygeal areas.     At an orthopedic evaluation on 6 October 2005 the CI reported pain in the gluteal area and the anterior inner groin area medially.  X-rays dated 7 October 2005 demonstrated evidence of an ORIF of a left ileal fracture as well as fractures of the left superior and inferior pubic rami, while X-rays of the left hip were normal.  

The 7 October 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily discomfort and the CI was unable to do any lifting and had difficulty kneeling and getting into more awkward positions that he needed to perform his job.  No physical examination was performed; however, X-ray studies of AP (anterior posterior) pelvic and Judet views (45 degree obliques of the affected hip) showed the hardware (73 mm screw) from anterior to posterior into the sacroiliac joint, which appeared to be well reduced and the 2 reconstruction plates in the posterior ilium that also appeared to have had a healed ilial fracture. There was some heterotopic ossification (bone formation) present about the insertion sites for some of the hardware.  The anterior pubis symphysis remained disrupted and was separated by a couple of centimeters. The left ASIS (anterior superior iliac spine) was high riding and rotated and the contour was not perfectly reduced.  It did not appear to be terribly off on the AP view, but on the Judet views, the contour, particularly at the pelvic floor, more so on the left side appeared to be somewhat distorted. The hips did not appear to have any arthritic changes within them.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, coded 5299-5236 (sacroiliac injury and weakness), citing status post pelvic fracture and sacroiliac joint disruption, status post open reduction and internal fixation with minimal functional impairment.  The VA rated the left hip condition 0%, coded 5252 (thigh, limitation of flexion), based on the service treatment record, citing non-compensable evaluation in the absence of objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement; or, unless the thigh is limited in flexion to 45 degrees.  Members considered ratings using codes for the hip and thigh; however, there was no hip ankylosis (5250), no limitation of thigh extension or thigh flexion (5251, 5252), no thigh impairment (5253), no flail joint of the hip (5254), or any femur impairment (5255) on which to base a higher rating.  Nevertheless, despite the limited physical examinations and the VASRD limitation of not having specific rating for fractures of the pelvis, VASRD §4.67 (pelvic bones) states:  “The variability of residuals following these fractures necessitates rating on specific residuals, faulty posture, limitation of motion, muscle injury, painful motion of the lumbar spine, manifest by muscle spasm, mild to moderate sciatic neuritis, peripheral nerve injury, or limitation of hip motion.”  Although the CI had no ratable limitation of motion of the hip or back, muscle injury, muscle spasm, mild to moderate sciatic neuritis, or peripheral nerve injury, he did have faulty posture based on X-ray findings of the high riding and rotated ASIS, with the left side having appeared distorted along with a separated symphysis pubis.   The CI had pain with running and lifting, although objective painful motion during examination was not recorded in the STR, but the CI did walk with a left limp and had decreased muscle strength (4/5) on the left compared to the right along with pain on palpation of the left SI joint and left posterior hip.  Therefore, use of code 5099-5003 with a 10% rating is not unreasonable, based on painful motion when running or lifting or while limping.  Furthermore, use of analogous code 5399-5317 at 20% is not unreasonable, albeit actual muscle injury was not documented, for a moderate disability (Group XVII. Function:  Extension of hip (1); abduction of thigh; elevation of opposite side of pelvis (2, 3); tension of fascia lata and iliotibial (Maissiat's) band, acting with XIV (6) in postural support of body steadying pelvis upon head of femur and condyles of femur on tibia (1). Pelvic girdle group 2: (1) Gluteus maximus; (2) gluteus medius; (3) gluteus minimus), based on pelvic distortion and functional limitation of lifting and getting into more awkward positions to perform his job.    Panel members also considered a rating under VASRD §4.66 (sacroiliac joint), but while there was traumatic disruption at the time of separation, there was no lumbosacral strain, painful motion other than noted when running, lifting, or going into awkward positions as part of his job, or paralysis.  Nevertheless, the analogous code 5299-5236 does provide a more precise anatomical localization of the disability.  Therefore, the issue of objective painful motion when using code 5099-5003 is moot.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the status post pelvic fracture and sacroiliac joint disruption condition, coded 5299-5236.  

PANEL FINDINGS:  In the matter of the status post pelvic fracture and sacroiliac joint disruption condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5236 IAW VASRD §4.71a.  There are 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	
Status Post Pelvic Fracture and Sacroiliac Joint Disruption (Left Hip)	5299-5236	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02448.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR