RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00205
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E2, Health Care Specialist Trainee, medically separated for “left sacroiliac stress fracture” and “right distal femoral stress fracture,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20070206	VARD - 20160331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Sacroiliac Stress Fracture	5236	10%	Residual of Sacroiliac Injury/Fracture	5236	0%	20160308	
Right Distal Femoral Stress Fracture	5099-5003	0%	Right Femur Stress Fracture (limitation of abduction and adduction)	5252	0%		
			Right Femur Stress Fracture (limitation of flexion)	5253	0%		
Adjustment Disorder	Not Unfitting 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Sacroiliac (SI) Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left SI pain condition began in June 2006 while in Basic Training as hip pain without trauma or injury.  A bone scan in August 2006 confirmed stress fracture of the medial side of the left SI joint.  After treatment with anti-inflammatory medications, physical therapy and activity limiting profiles the CI’s SI pain did not significantly improve.  There was no surgical indication.  

The 20 December 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of lower extremity pain without specificity for site.  The physical examination showed normal gait, minor tenderness over the left sacroiliac joint with lumbosacral range of motion (ROM) measured as flexion to 90 degrees (normal) and combined ROM of 230 degrees (normal 240).  

There was no VA Compensation and Pension (C&P) evaluation in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left SI stress fracture condition 10%, coded 5236 (sacroiliac injury and weakness), citing thoracolumbar range of motion limited by pain, with localized tenderness.  The VA rated the left hip condition 0% coded 5236, based on the VA C&P examination 9 years after separation, citing range of motion within normal limits.  

The panel agreed that a 10% rating, but no higher, was justified for a combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  

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 SI joint stress fracture condition.  

Right Distal Femoral Stress Fracture.  According to the STR and the MEB NARSUM, the CI’s lower extremity pain condition began sometime after September 2006 after beginning her military occupational specialty (MOS) training.  A November 2006 bone scan showed a stress reaction to the right distal femur.  After treatment with anti-inflammatory medications, physical therapy and activity limiting profiles the CI’s distal right femur pain did not significantly improve.  There was no surgical indication.  

The 20 December 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of lower extremity pain without specificity for site.  The physical examination showed a normal gait and no tenderness or edema at the right femur.  Right knee ROM was recorded as flexion to 140 degrees (normal) and extension to 0 degrees (normal).  There was no VA C&P evaluation in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right distal femoral stress fracture condition 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing not verified by X-ray and without limitation of motion.  The VA also rated the right femur stress fracture condition 0%, coded 5252-5253 (thigh, limitation of flexion - thigh, impairment of) based on the VA C&P examination 9 years after separation, citing a non-compensable evaluation.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was also no evidence of painful motion with functional loss supporting a minimum rating (based on §4.59, §4.40 and §4.45).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, nonunion, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 0% adjudicated by the PEB 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 right distal femur stress fracture condition.  

Contended PEB Condition:  Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left SI joint stress fracture condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the distal right femur stress fracture condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  

In the matter of the contended adjustment disorder condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20160408, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014103, 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