RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00462
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040823

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Utilities Systems Journeyman, medically separated for “osteitis pubis status post childbirth” with a disability rating of 10%.

CI CONTENTION:  “Member is and has undergone numerous treatments to correct condition, to include two surgeries, with no pain relief.  The rating was given with regards of condition improving.  Condition has worsened, and member has difficulty keeping a job due to condition.”  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 - 20040629	VARD - 20050420 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteitis Pubis Status-Post Childbirth	5022	10%	Osteitis Pubis	5299-5298	10%	20050207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Osteitis Pubis Status-Post Childbirth.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first complained of pubic pain in August 2003 (12 months before separation) when she returned to duty after childbirth, reporting an onset at the time of delivery.  Multiple imaging studies (X-ray, ultrasound, CT, bone scan) were normal; and; multiple consultations and work-ups did not identify a specific etiology.  The only positive physical finding was tenderness of the pubic bone, yielding a diagnosis of osteitis pubis (inflammation of the pubic bone).  The CI’s pain did not respond to medication trials, attempted local injections or activity restriction; and, a surgical option was considered but advised against.  There was STR documentation of a grossly normal spine and hip range of motion (ROM), normal gait and normal neurological findings. 

The 10 May 2004 NARSUM examination, 3 months prior to separation, documented non-specific pain “localized to her pubic bone” (characterized as constant and rated 7-10/10 in a contemporary STR entry) that precluded “excessive lifting, squatting, excessive walking or stair climbing.”  The physical examination was remarkable only for “significant” tenderness of the pubic bone. 

The 7 February 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, documented non-specific “pain in her pubic bone” that was aggravated by prolonged standing and sitting, and that prohibited running or squatting.  The physical examination recorded normal posture and gait, “mild” pubic bone tenderness, “full” ROM of the spine and all major joints, and normal neurological findings (5/5 strength). 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating was under code 5022 (periostitis) that defaults to criteria of 5003 (degenerative arthritis).  Although no rationale was cited, concession of painful motion would be required to support the PEB rating under that code.  The VA’s 10% rating, based on the C&P evidence, was under code 5299-5298 (analogous to removal of the coccyx), citing the criterion of “painful residuals” for the maximum 10% rating.  There is no specific VASRD code for this condition; and, there are no additional coding options, analogous or otherwise, that would be applicable and favorable.  There was no ROM limitation, or other ratable criterion in evidence, that would justify a rating higher than 10% under any 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 of the osteitis pubis condition. 

BOARD FINDINGS:  In the matter of the osteitis pubis condition 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 20160721, w/atchs
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-2016-00462.

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