RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00480
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Intelligence Analyst, medically separated for “chronic left groin pain due to inferior pubic ramus stress fracture” with a disability rating of 0%.  

CI CONTENTION:  “I was medically discharged due to a stress fracture on my left pelvis.  I also had injuries to my lower back, bi-lateral feet, left hand/arm pain, as well as shin splints.  My subsequent injuries were never considered during the MED-BOARD process claiming the process would have delayed my discharge.”  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 - 20050810	VARD - 20080505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Groin Pain Due to Inferior Pubic Ramus Stress Fracture	5099-5003	0%	Status Post Left Inferior Pubic Ramus Stress Fracture	5252	10%	20080312	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Groin Pain Due to Inferior Pubic Ramus Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain and pubic ramus stress fracture condition began in December 2004 while running during basic training.  Serial X-rays revealed a left inferior ramus (pelvis) stress fracture.  Following convalescent leave, left hip pain returned with resumption of training activities.  During the 14 June 2005 physical therapy (PT) examination, 2 months prior to separation, the CI reported worsening pelvic pain.  Physical examination showed an abnormal gait, but did “not appear painful to ambulate.”  Hip range of motion (ROM) was normal with left (greater than right) hip pain on resisted straight leg raise, mild pain with adduction and mild pain on squatting.  

The 25 July 2005 MEB NARSUM and MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, noted complaints of left groin and hip pain.  The CI reported using Aleve as needed for pain.  Physical examination showed a slightly antalgic gait with tenderness at the left inferior pubic ramus and inguinal fold.  There was “full” hip ROM (no measurements provided) and negative straight leg raise, heel tap, and log roll.  Strength was normal and there was no neurovascular deficit.  

At the 12 March 2008 VA Compensation and Pension (C&P) evaluation, 32 months after separation, and the CI reported constant left hip pain exacerbated by sitting.  Physical examination showed painful left hip motion with flexion of 90 degrees, extension of 20 degrees, abduction of 45 degrees, and internal/external rotation 40/60 degrees.  Motor and neurologic examinations were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin pain and pubic ramus stress fracture condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing full ROM and “rated for pain – moderate, intermittent,” with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the left inferior ramus stress fracture condition 10%, coded 5252, (thigh, limitation of flexion), based on the C&P examination 32 months after separation, citing right hip ROM.  

The panel adjudged that the STR had the highest probative value for rating at separation due to the remoteness of the C&P examination.  The panel considered VASRD §4.67 (pelvic bones) and noted that there was no muscle injury, or peripheral nerve injury for rating other than under VASRD §4.71a (musculoskeletal system).  The PT examination provided objective evidence of painful motion and the MEB examination showed a slightly antalgic gait providing sufficient objective evidence of painful motion and/or functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or thigh impairment for greater than a 10% rating (codes 5251, 5252, or 5253).  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 left groin pain and pubic ramus stress fracture condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left groin pain and pubic ramus stress fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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	
Chronic Left Groin Pain Due to Inferior Pubic Ramus Stress Fracture	5009-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

AR20170015697, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure