RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01273
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic groin pain secondary to left inferior pubic ramus stress fracture” with a disability rating of 0%.  

CI CONTENTION:  Left ankle condition was never treat and her pubic ramus fracture has worsened.  She suffers from depression and excruciating migraines and believes her rating should be increased.  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 - 20040809	VARD - 20050816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Groin Pain Secondary to Left Inferior Pubic Ramus Stress Fracture	5099-5003	0%	Status Post Left Inferior Pubic Ramus Stress Fracture	5299-5024	10%	20050411	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Groin Pain Secondary to Left Inferior Pubic Ramus Stress Fracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s stress fracture occurred in December 2003 when she fell while running during basic training and pulled a groin muscle.  X-rays showed a left inferior pubic ramus stress fracture.  She was treated and placed on convalescent leave for 30 days.  She returned and resumed basic training, but re-injured the area again while running.  She was treated with physical therapy and placed on convalescent leave a second time.  
During the 7 July 2004 MEB examination (recorded on DD Forms 2807-1, 2808 and 2697), approximately 2 months prior to separation, the CI complained of chronic pain from the pelvic stress fracture which prevented running or standing and impaired the use of her legs.  She reported the groin and hip areas were constantly inflamed and that she could not stand for more than 5-10 minutes.  

At a 20 July 2004 physical therapy appointment, range of motion (ROM) showed left hip flexion to 113 degrees (normal 120), extension to 8 degrees (normal 15), adduction to 22 degrees (normal 30), abduction to 36 degrees (normal 45), internal rotation to 50 degrees (normal 45) and external rotation to 55 degrees (normal 45).  There was pain with flexion and crossed adduction.  

The 22 July 2004 MEB NARSUM examination, 1 month prior to separation, noted complaints of left groin pain at rest with aggravation caused by running, stairs, and some types of exercise. Rest, but not medication, helped reduce the pain.  Physical examination revealed a normal gait and localized tenderness to the left inferior pubic ramus, with slightly painful ROM but negative log roll and heel tap.  Strength was normal and neurovascular findings intact.  The examiner referred to the PT ROM examination for measurements.  

At the 11 April 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported being 16 weeks pregnant.  She had constant, dull hip and pelvis pain and could not climb steps.  She denied incapacitation or time lost from work and could perform all activities of daily living.  Physical examination showed normal gait and posture with some tenderness in the pelvic area. There was no leg length difference, and right and left hips were normal with full active ROM.  There were no DeLuca or neurological deficits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the groin pain secondary to the inferior pubic ramus stress fracture 0%, analogously coded 5099-5003 (arthritis, degenerative), citing no loss of joint motion.  The VA rated the inferior pubic ramus stress fracture condition 10%, analogously coded 5299-5024 (tenosynovitis), based on the C&P examination 8 months after separation, citing pelvic area tenderness area.  The panel considered whether there was a pathway to a higher rating.  There was no evidence of limitation of motion (5251, 5252, 5253) or ankyloses of the hip (5250), but the NARSUM and the physical therapy examinations showed evidence of painful motion (VASRD §4.59).  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 groin pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic groin pain secondary to the left inferior pubic ramus stress fracture, 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 Groin Pain Secondary to Left Inferior Pubic Ramus Stress Fracture	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160922, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170019477, 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