RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-00829
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050711

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Field Artillery Cannoneer, medically separated for “pelvic pain due to stress fractures” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20050622	VARD - 20051122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Due to Pelvic Stress Fractures	5099-5003	10%	Residuals, Fractured Left Hip	5252	10%	20050909	
			Residuals, Fractured Right Hip and Pubic Ramus	5252	10%	20050909	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Pelvic Pain Due to Stress Fractures. The PEB combined the pelvic stress fractures under a single disability rating analogously to 5003 and rated 10% with application of the US Army Physical Disability Agency pain policy and AR 635-40 B24.f. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid

ratings. The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB. The evidence for the left and right hip conditions is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s pelvic condition began in March 2005 after running during physical training when he experienced a sharp pain in the lower pelvis as well as pain radiating to the hamstring area of the buttocks bilaterally. The 24 March 2005 bone scan revealed stress fractures of the pubic bones and hip socket bilaterally. At the 23 May 2005 physical therapy examination the CI reported bilateral hip pain into the groin. Physical examination showed an antalgic gait and full, bilateral hip range of motion (ROM) with pain. During the 9 June 2005 MEB examination (recorded on DD Forms 2807- 1 and 2808), one month prior to separation, there was tenderness of the pelvic bones (pubic rami). The same-day MEB NARSUM examination showed bilateral pubic rami tenderness. Gait was normal.

At the 2 September 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pelvic and hip pain bilaterally. Physical examination showed pain on either side of his testicles and painful motion in both hips. Forward flexion was to 110 degrees on the right and 120 degrees on the left (normal 125); extension was 45 degrees on the right and 30 degrees on the left (normal 20); and abduction was 40 degrees bilaterally (normal 45).

The panel directed attention to its rating recommendation based on the above evidence. As noted above, the PEB bundled the pelvic condition and applied a single rating 10%, analogously coded 5003 (degenerative arthritis), citing the rating for slight/frequent pain IAW the US Army Physical Disability Agency pain policy. The VA rated each hip-pelvic condition 10%, coded 5252 (thigh limitation of flexion), based on the C&P examination, citing limitation of motion due to pain.

The panel noted that it would be speculative to separate the pain resulting from the rami versus acetabular stress fractures and determined that stress fractures in the pelvic region contributed to chronic pain. The panel then considered if each pelvic bone condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The chronic pain from both bones was profiled, implicated in the commander’s statement, and failed retention standards. Panel members agreed the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties, and accordingly separate disability ratings are recommended.

The panel then turned to a rating recommendation and noted that VASRD §4.67 (pelvic bones) rates pelvic bone fractures based on specific residuals. The residual in this case was painful, limited hip motion. There was no compensable limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5252, 5251). However, there was evidence of painful motion with functional loss supporting a 10% rating for each hip (based on VASRD §§4.59, 4.40 and 4.45). After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip condition and 10% for the left hip condition, both coded 5252 for a combined 20% rating.

BOARD FINDINGS: In the matter of the chronic pain due to pelvic stress fractures, the panel recommends that each hip be adjudicated as follows: an unfitting right hip condition coded 5252 and rated 10%, and an unfitting left hip condition, coded 5252 and rated 10%, both IAW VASRD
§4.71a.  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 Pelvic Stress Fracture	5252	10%	
Right Pelvic Stress Fracture	5252	10%	
	COMBINED	20%	

AR20190012140, 

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.