RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00430
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Communications Network Switching & Crypto Systems Journeyman, medically separated for “chronic pelvic bone pain” with a disability rating of 20%.   

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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20070220	VARD - 20070511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pelvic Bone Pain	5315	20%	Non-Union Fracture of Pelvis Pubis	5255	30%	20070203	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Pelvic Bone Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pelvic bone pain condition began in October 2003 after he sustained a groin strain during training due to a sudden twisting motion.  The CI later aggravated his condition in June 2004 after heavy equipment struck his left pelvic area.  Pelvic imaging in July 2005 showed an avulsion fracture of the inferior pubis at the insertion of the adductor magnus muscle (thigh adduction) and “minor” atrophy of the adductor magnus muscle.  Subsequent imaging showed likely non-union of the fracture.  However, magnetic resonance imaging and bone scan in March 2006 showed no abnormality of the pubic symphysis region.  No surgery was recommended.

The 21 November 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain with activities such as running, jumping, climbing stairs, lifting and dancing.  Physical examination showed tenderness to palpation of the left pubic symphysis.  There was pain with extension, abduction, adduction, and internal rotation of the hip.  

At the 3 February 2007 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported constant pain in the area of that avulsion fracture aggravated by activities and relieved by anti-inflammatory medications.  The CI reported that at the time of pain he could function with medication.  Physical examination showed an antalgic gait.  Left hip range of motion was flexion 60 degrees (normal 125), extension 15 degrees (normal 20), abduction 15 degrees (normal 45), adduction 8 degrees (normal 45), and external rotation 7 degrees (normal 45).  The left hip motion was additionally limited by pain, fatigue, weakness, lack of endurance and incoordination after repetitive use, but there was no additional loss of ROM in degrees.  Motor and sensory examination was normal.  Pelvic and left hip X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pelvic bone pain condition 20%, coded 5315 (Group XV. Function: Adduction of hip), citing condition rated as moderately severe.  The VA rated the pelvic bone pain condition 30%, coded 5255, (femur, impairment of), citing marked hip disability.  The PEB assigned a 20% rating with muscle code 5315 and therefore the panel reviewed to see if a higher rating was supported.  There was no evidence to support characterizing the adductor muscle injury as “severe” as specified by VASRD §4.56 (evaluation of muscle injuries) for higher rating with this code based on the mechanism of injury, history, complaints, or objective clinical findings in record.  The panel next considered alternative VASRD §4.71a codes (musculoskeletal conditions.  There is no higher than a 10% rating available under 5003 for painful, limited motion of a single major joint.  There was no evidence of femur impairment (5255), sufficient limitation of thigh flexion (5252) or evidence of hip ankyloses (5250) to support a rating higher rating under these codes.  There was therefore no higher rating available under any applicable VASRD code than 20% as adjudicated by the PEB.  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 chronic pelvic bone pain condition.    

BOARD FINDINGS:  In the matter of the chronic pelvic bone pain condition and IAW VASRD §4.73, 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 20160705, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00430.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings