RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01380
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Basic Marine, medically separated for “right sacral stress fracture” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040521	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Sacral Stress Fracture	5099-5003	10%	Right Sacral Stress Fracture	5255	10%	20050725	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Sacral Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right sacral stress fracture condition began in February 2004 after falling on a foot locker.  Plain film X-rays and CT scan of the area were negative for fracture.  Bone scan on 19 March 2004 demonstrated a small focus of increased activity adjacent to the right sacroiliac (SI) joint consistent with a sacral stress fracture.  She was transferred to the rehabilitation platoon and after 3 weeks she was pain-free.  When she returned to a walk-to-run program and began having pain again.  

The 4 May 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of right hip pain that required crutches for ambulation.  Physical examination showed mild tenderness over the right SI joint.  

At the 21 July 2005 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported intermittent right hip pain aggravated by prolonged sitting, driving, walking, standing, lifting or sleeping on her right hip.  Physical examination demonstrated right hip flexion to 130 degrees (normal 125), abduction to 30 degrees (normal 45), adduction to 20 degrees but the ability to cross legs was not addressed; external rotation was to 40 degrees (normal 45) with pain at the end of flexion and other motions except internal and external rotation.  Gait was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right sacral stress fracture condition 10%, coded 5099-5003 (analogous to degenerative arthritis).  The VA also rated the right sacral stress fracture condition 10%, coded 5255 (femur, impairment, malunion), based on the C&P examination, citing pain on motion.  

The panel agreed there was insufficient limitation of range of motion of the hip to provide a minimum rating using VASRD codes 5251 (thigh, limitation of extension), 5252 (thigh, limitation of flexion) or 5253 (thigh impairment).  In addition, there was no indication of a flail joint of the hip to support an 80% rating using code 5254, ankylosing of the hip to support a 60% rating using code 5250 or malunion of a femur fracture to support a 10% or higher rating using code 5255.  The panel also noted SI joint injuries (5236) may be rated using the General Rating Formula for Diseases and Injuries of the Spine, and localized tenderness of the SI joint satisfies the requirements for a 10% rating under that formula but this did not represent a rating advantage to the CI.  There are no other applicable codes.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right sacral stress fracture condition.  

BOARD FINDINGS:  In the matter of the right sacral stress fracture condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161005, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN