RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2016-00863 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20041028

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Healthcare Specialist, medically separated for “chronic lower extremity pain, due to stress fractures” with a disability rating of 0%.

CI  CONTENTION:	“Stress  fractures  in  pelvis…back  issues  and  feet  issues.”	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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20041014	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Extremity Pain…	5099-5003	0%	
No VA Examination in Evidence	
Lower Back Pain	Not Unfitting		
Bilateral Feet Numbness and Tingling	Not Unfitting		
Pes Planus, Moderate	Not Unfitting		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Chronic Lower Extremity Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced right hip pain after a road march in January 2004 during which she fell in icy conditions. In February 2004, a bone scan showed bilateral superior pubic ramus fractures, along with a likely right first metatarsal stress fracture. In May 2004, X- rays revealed healing pubic rami stress fractures on both sides. A pelvis/hip MRI in June 2004 demonstrated increased signal over the areas mentioned above as well as the left sacral region, consistent with stress reaction versus stress fracture.

During the 21 June 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported bilateral hip pain. Physical examination showed bilateral groin tenderness, but a normal gait, and full range of motion (ROM) in both hips with pain during abduction and adduction. The 31 August 2004 MEB NARSUM addendum examination, 2 months before separation, noted

complaints of bilateral groin pain rated at 5/10. The examiner noted a normal gait and only documented passive ROM, with left hip flexion to 95 degrees (normal 135), right hip flexion to 100 degrees, and normal abduction bilaterally, with pain in all planes. Moderate pes planus (flat foot) was also noted.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the stress fractures 0%, analogously coded 5099-5003 (osteoarthritis), citing pain with application of the US Army Physical Disability Agency pain policy. Panel members first considered whether each hip/groin could be reasonably justified as separately unfitting. In this case, the bilateral pubic stress and right first metatarsal fractures were considered to fail retention standards. The bilateral pubic stress fractures were implicated by the NARSUM and the commander’s statement and profiled. Thus, the panel agreed that each hip could be reasonably justified as unfitting. However, the right first metatarsal stress fracture was not implicated by the NARSUM or the commander’s statement, and was not profiled, and so panel members agreed the evidence did not support an unfitting right foot stress fracture. The panel then considered its rating recommendation, and agreed that while there was no compensable limitation of hip flexion, extension, or abduction (5251, 5252, or 5253), there was evidence of painful motion with functional loss supporting a 10% rating for each hip (based on §4.59, §4.40 and §4.45). After due deliberation, considering all the evidence, the panel recommends a disability rating of 10% for the right pubic stress fracture, and a 10% for the left pubic stress fracture, coded 5099-5022 (periostitis).

Contended PEB Conditions: Lower Back Pain, Bilateral Feet Numbness and Tingling, Pes Planus. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The sacral (lower back) condition was profiled but did not fail retentions standards. The foot conditions were not profiled and did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the bilateral hip condition, the panel recommends that each hip be separately adjudicated as follows: an unfitting right pubic stress fracture condition coded 5099-5022 and rated 10%, and an unfitting left pubic stress fracture condition, coded 5099- 5022and rated 10%, both IAW VASRD §4.71a. In the matter of the right metatarsal stress fracture, the panel recommends it as not unfitting. In the matter of the contended lower back pain, bilateral feet numbness and tingling, and pes planus, the panel recommends no change from the PEB determinations as not unfitting. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Pubic Stress Fracture	5099-5022	10%	
Right Pubic Stress Fracture	5099-5022#	10%	
	COMBINED	20%	

AR20190014183,XXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

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.