RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-02324 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090403

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, E3 Military Policewoman, medically separated for “bilateral inferior pubic rami stress fractures” with a disability rating of 20%.

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 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 – 20090313	VARD - 20091202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Inferior Pubic Rami Stress Fractures	5299-5255	10%	Left Pubic Ramus Stress Fracture	5299-5252	10%	20091023	
	5299-5255	10%	Right Pubic Ramus Stress Fracture	5299-5252	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Bilateral Inferior Pubic Rami Stress Fractures. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral hip condition began approximately in January 2008 when she developed vague groin pain. X-rays in June 2008 showed bilateral symmetrical healing stress fractures of the inferior rami and a bone scan revealed increased uptake in the inferior pubic rami bilaterally.

At the 30 January 2009 orthopedic examination, 3 months prior to separation, the CI complained of groin pain and pain about the greater trochanter with walking long distances. Physical examination showed easy ambulation, but there was some tenderness over the greater trochanters. A physical therapy clinic visit on 23 February 2009, 2 months prior to separation, showed a mild, slow antalgic gait bilaterally. Range of motion (ROM) testing of the hips, after repetition, showed right flexion of 105 degrees (normal 125), extension of 5 degrees (normal 0) and abduction of 20 degrees (normal 45); and left flexion of 95 degrees, extension of 5 degrees, and abduction of 15 degrees. The 26 February 2009 MEB NARSUM examination, 2 months prior

to separation, noted complaints of groin pain. Physical examination of the hips revealed pain with active flexion, abduction and adduction.

At the 15 October 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported bilateral hip pain. Physical examination revealed a normal gait, no evidence of abnormal weight bearing, no loss of a bone or part of a bone and no sign of arthritis. The examiner noted pain at rest and guarding of movement in both hips. There was tenderness to the inguinal area/pubic rami bilaterally. Left and right hip ROM testing showed flexion of 125 degrees, extension of 30 degrees and abduction of 45 degrees, with objective evidence of pain following repetitive motion. The CI was able to cross both legs and toed out greater than 15 degrees bilaterally.  X-rays of the hips and pelvis were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left and right hip conditions 10% each, analogously coded 5299-5255 (femur, impairment of), citing slight hip disability. The VA also rated the left and right hip conditions 10% each, analogously coded 5299-5252 (limitation of thigh flexion), based on the C&P examination, citing evidence of pain in the left and right hips following repetitive motion. The panel considered other VASRD hip and analogous codes, but all were less applicable or not advantageous to rating. There was therefore no higher rating than the 10% adjudicated by the PEB, for either hip, available under any applicable VASRD code. 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 bilateral hip condition.

BOARD FINDINGS: In the matter of the bilateral hip 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 20170223, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record
PD-2017-02324 

AR20190015711, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      

Enclosure

PD-2017-02324