RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02334 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070313

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Combat Medic Trainee medically separated for “left pubic ramus stress fracture” with a disability rating of 10%.

CI CONTENTION: Review requested of additional conditions (spine, hearing and body pain) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070227	VARD - 20080514	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Left Pubic Ramus Stress Fracture	
5099-5003	
10%	Healed, Left Pubic Stress Fracture with Groin Pain	5099-5003	0%	20080118	
			Mech. Low Back Pain…Healed Left Pubic Stress Fracture …	5237	0%	20080118	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Left Pubic Ramus Stress Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced left groin pain during basic training, and X-rays in August 2006 noted a left inferior pubic ramus non-displaced fracture with early callus formation. The  25 January 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of left groin pain exacerbated by impact activities. Physical examination revealed a mild antalgic gait favoring the left leg, mild pain with straight leg raising, and a positive FABER's test (leg flexion,

abduction, with external rotation movement causing pain), but negative log roll and heel tap. Passive left hip range of motion (ROM), in degrees, was flexion to 110 (normal 125), external rotation to 50 (normal 60), internal rotation to 25 (normal 40), abduction to 45 (normal), and extension to 15 (normal 30), with increased pain at the upper limits of all ranges.

At the 4 December 2007 and 18 January 2008 VA Compensation and Pension (C&P) examinations, 9 months after separation, the CI reported left groin pain. Physical examination revealed tenderness over the left ischium, groin, and paraspinal muscles. Patrick's testing was positive, while Gaenslen's testing was negative (pain with specific leg movements). Left hip and back ROMs were measured as “normal” in each plane without pain on repetition, and the remainder of the examination was unremarkable. An X-ray revealed a healed fracture at the junction of the left inferior pubic rami/ischium.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left pubic ramus stress fracture (pelvis) 10%, analogously coded 5099-5003 (degenerative arthritis). The VA rated the left pubic ramus stress fracture 0%, analogously coded 5099-5003, based on the C&P examination, citing no higher rating without objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement. Panel members considered the tenants of VASRD §4.67 (pelvic bones) and determined the CI’s residuals for rating were predominantly hip related. The panel noted there was no evidence of hip ankylosis (code 5250), thigh limitation of flexion (code 5252), thigh impairment (code 5253), hip flail joint (code 5254), or femur impairment malunion with moderate hip disability (code 5255). However, there was sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). There was normal anatomic alignment without abnormal sclerosis, arthritic or inflammatory changes. Regarding an alternative analogous back rating, panel members agreed that although there was an antalgic gait, there was no back spasm or guarding responsible for the antalgic gait, and no abnormal contour, limitation of motion, or incapacitating episodes that would provide for any rating higher than the 10% assigned by the PEB at the time of separation. 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 left pubic ramus stress fracture.

BOARD FINDINGS: In the matter of the left pubic ramus stress fracture 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 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190012150, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXX

	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