RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02605
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic pain, due to pubic rami stress fractures” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions” as well as additional conditions 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 - 20060417	VARD - 20070213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain due to Pubic Rami Stress Fractures	5099-5003	10%	Sacroiliitis	5236-5315	20%	20061216	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

[Left] Pubic Rami Stress Fractures.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s intermittent left groin pain began insidiously during basic training.  A bone scan showed tracer uptake of both the left inferior pubic ramus (IPR) and superior pubic ramus (SPR) consistent with healing stress fractures.  Pelvis X-rays in September 2005 showed callus formation around an old left IPR stress fracture with a stable appearance.   At a physical therapy (PT) examination on 23 September 2005, 7 months prior to separation, the CI reported generally improved left hip/groin pain, but increased pain with strenuous activity.  Physical examination showed left IPR tenderness and full active hip range of motion (ROM) with pain at the end range of external rotation.  A PT visit on 1 November 2005 noted mild pelvis pain that improved with stretching.  

During the 21 Feb 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported sacroiliac (SI) joint inflammation with hip and pelvic pain.  A back ROM evaluation showed flexion to 90 degrees (normal) and combined ROM of 240 degrees (normal).  Left hip flexion was to 95 degrees (normal 125) and abduction to 35 degrees (normal 45), with normal extension and adduction.  Strength, sensation, and reflexes were normal.  The 9 March 2006 MEB NARSUM examination noted complaints of left groin pain.  Physical examination showed normal gait and stance.  There were mild symptoms on straight leg raise testing and a positive FABER’s test (pain with flexion, abduction and external rotation of the hip).  Passive hip ROM showed mildly decreased flexion and extension, limited by pain.  

At a 25 May 2006 VA outpatient physical medicine and rehabilitation examination, 1 month after separation, the CI reported bilateral hip pain rated at 3/10.  Physical examination showed normal left hip and lumbar areas.  Lumbar spine X-rays showed a normal vertebral variant (hemisacralization of L5), but was otherwise unremarkable.  A PT examination on 31 May 2006 showed a normal gait.  There was no limitation in hip rotation, and trunk motion was within functional limits with flexion to toes (normal), extension to 45%, and side bending to 50% bilaterally (combined ROM of at least greater than 120 degrees).  A bone scan in July 2006 was negative, without evidence of sacroiliitis.  

At the 16 December 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported chronic bilateral hip pain with giving way, stiffness, weakness, incoordination and tenderness, but denied locking, effusions or flare-ups.  Physical examination showed a normal gait and left hip tenderness.  Left hip ROM was normal in all planes with painful motion noted, but there was no additional loss of motion with repetitive use.  The CI was able to cross her legs and toe out more than 15 degrees.   Bilateral hip X-rays showed an old fracture deformity in the IPR area.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight and frequent pain IAW the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left groin condition 20%, dual coded 5236-5315 (SI injury and weakness-muscle group 15 injury), based on the C&P examination.  According to VASRD §4.67, fractures of the pelvic bones are to be rated based on the specific residuals.  The CI reported chronic left groin pain with painful hip ROM and SI joint pain.  A 10% rating was supported for painful motion of the left hip coded 5299-5252 (analogous to limitation of thigh flexion) based on §4.59, §4.40 and §4.45.  The panel considered other VASRD hip codes and all were less applicable.  Alternatively the pelvic stress fractures could be rated 10% based on sacroiliac tenderness, coded 5299-5236 (sacroiliac injury and weakness).  According to VASRD §4.66, the lumbosacral and sacroiliac joints are to be considered as one segment for rating purposes.  There was no spinal muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus a 20% rating (under a spinal code) was not justified on this basis.  There was therefore no higher than a 10% rating supported under any applicable VASRD code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to achieving the highest rating and therefore no change to the PEB’s coding choice is recommended.  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 groin condition.  

BOARD FINDINGS:  In the matter of the left groin 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190011695, 

Dear XXXXXXXXXXXXXXXXXX:

	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.