RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-03848 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090608

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

CI CONTENTION: “These issues have worsened and have caused new issues.” 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 - 20090330	VARD - 20091015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Pubic Ramus Stress Fracture	5299-
5255	10%	Right Hip Inferior Pubic Ramus Stress Fracture	5299-5252	0%	20081121	
Left Hip Pain	Not Unfitting	Left Hip Stress Fracture	5299-5252	NSC	STR*	
Bilateral Carpal Tunnel Syndrome	Not Unfitting	Right Carpal Tunnel Syndrome	8599-8515	NSC	STR*	
		Left Carpal Tunnel Syndrome	8599-8515	NSC	STR*	
Bilateral Cubital Tunnel Syndrome	Not Unfitting	Right Elbow Nerve Damage	8599-8516	NSC	STR*	
		Left Elbow Nerve Damage	8599-8516	NSC	STR*	
Bilateral Shin Splints	Not Unfitting	Right Shin Splints	5299-5262	NSC	STR*	
		Left Shin Splints	5299-5262	NSC	STR*	
Bilateral Knee Pain	Not Unfitting	Right Knee	5299-5260	NSC	STR*	
		Left Knee	5299-5260	NSC	STR*	
Gastroesophageal Reflux Disease [GERD]	Not Unfitting	Acid Reflux	7399-7346	10%	20090812	
Mild HF Hearing Loss, Right Ear	Not Unfitting	Bilateral Hearing Loss	6100	NSC	20081121	
Hypertension	Not Unfitting	Hypertension	7101	0%	20090812	
Severe Dysplasia	Not Unfitting	Cervical Dysplasia	7699-7612	NSC	20090810	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
* Failed to report for VA bones and joint examination and peripheral nerve examination.

ANALYSIS SUMMARY:

Right Pubic Ramus Stress Fracture. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced the onset of right hip pain at the end of basic training in October 2006, and an X-ray in December 2006 showed a stress fracture of the right inferior pubic ramus (pelvis). She had increased right hip symptoms after fast walking and also developed left hip pain. In July 2007, X-rays revealed thickening of the right inferior pubic ramus, and a bone scan in August 2007 showed a healing stress fracture.

At the 21 November 2008 dual MEB and VA Compensation and Pension (C&P) examination, 7 months before separation, the CI reported bilateral hip pain with decreased range of motion (ROM), aggravated by exercise, prolonged standing or walking, and with daily flares to 10/10 pain. Physical examination showed a normal gait and full bilateral hip flexion, extension, abduction, adduction, and internal and external rotation IAW VASRD limits. There was no limitation in ROM from pain, fatigue, weakness or lack of coordination with repetitive use. Bilateral lower extremity strength and reflexes were normal with no sensory deficit noted.

The 18 February 2009 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of ongoing hip pain with the inability to run, ruck march, carry a fighting load or do rushes. Physical examination revealed left hip tenderness and pain elicited by passive extension, abduction, and external rotation with the hip flexed (FABER test), but full active hip ROM without spasms. A back examination was normal, and there was no tenderness (on ambulation), lower extremity weakness, or sensory/reflex loss.  Hip X-rays in November 2008 were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right pubic ramus condition 10%, analogously coded 5299-5255 (femur impairment), citing the limited ROM measurements from a primary care visit on 12 February 2009. The VA rated the right pubic ramus condition 0%, analogously coded 5299-5252 (limitation of thigh flexion), based on the STR, citing failure to report for a scheduled VA bones and joint examination and the VASRD rating criteria for a non-compensable evaluation. Panel members considered VASRD §4.67 (pelvic bones) as the CI’s underlying pathology was a right pubic ramus stress fracture. There were no residuals such as faulty posture, limitation of motion, muscle injury, painful motion of the lumbar spine, muscle spasm, mild to moderate sciatic neuritis, peripheral nerve injury, or limitation of hip motion, that would warrant any rating higher than the 10% adjudicated by the PEB under any VASRD coding. 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 pubic ramus condition.

Contended PEB Conditions. The panel’s main charge is to assess the fairness of the PEB’s determination that left hip pain, bilateral carpal tunnel syndrome, bilateral shin splints, bilateral knee pain, GERD, mild HF hearing loss (right ear), hypertension, and severe dysplasia were not unfitting. The left hip condition was part of the 8 August 2007 L3 profile (“hip stress fractures with chronic hip pain”). A second profile with the same “wet” signatures and date also had U3H2 as well as L3; it listed the (bilateral) hip condition and additionally listed conditions of bilateral carpal tunnel syndrome and right ear hearing loss. The bilateral hip condition and bilateral carpal tunnel syndrome were listed as medically unacceptable by the MEB (failed retention standards). The commander’s statement did not implicate any specific diagnosis or condition. As noted by the PEB, there was no underlying pathology for the left hip pain or specific diagnosis other than joint pain. Left hip examination showed no ratable ROM limitations. The right-handed CI developed bilateral wrist pain, worse on the right, in early 2007 after repetitive use. She complained of difficulty with gripping and turning/pulling motions, as well as pain when putting any kind of pressure on her hands or wrists. In May 2007, an orthopedic specialist diagnosed bilateral carpal tunnel syndrome. Electrodiagnostic (EMG) testing in July 2007 was normal, and she had a right carpal tunnel release surgery in September 2007.  Anticipated left carpal  tunnel

surgery in 2008 was canceled due to pregnancy. A repeat EMG of the bilateral upper extremities in December 2008 was normal.

At the dual MEB and VA C&P examination, the CI reported bilateral wrist pain with tingling and numbness aggravated by writing and typing, and daily flares rated at 8/10. Upon examination, there were no physical signs of pain, and bilateral strength, reflexes, coordination, and sensation were normal. “All joints” had full ROM, normal muscle strength, and no pain, weakness, fatigue, palpable swelling, or joint effusion. The examiner recorded “right carpal tunnel release” as a diagnosis, but “no substantial clinical findings” to support left carpal tunnel syndrome.

At the MEB NARSUM examination, the CI complained of continued right hand pain, rated at 4- 5/10 with writing and repetitive movements, but that tingling and numbness was improved. She also reported persistent left hand pain, rated at 1-2/10 at rest, and increased to 6-7/10 with repetitive movements. Physical examination revealed no sensory loss and normal strength in all extremities except for a very minimal loss of left grip strength. Coordination and reflexes were normal. Although the examiner stated she was unable to do push-ups or carry/fire a weapon “because of her bilateral wrist pain,” the PEB specifically noted “no objective evidence to show how this limits the performance of her duties.” Panel members noted that aside from the NARSUM, there was scant evidence of significant duty restrictions attributable to either wrist.

None of the bilateral shin splints, bilateral knee pain, GERD, mild hearing loss (right ear), hypertension, or severe dysplasia conditions were profiled (at the “3” level) or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right pubic ramus condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended left hip pain, bilateral carpal tunnel syndrome, bilateral shin splints, bilateral knee pain, gastroesophageal reflux disease, mild HF hearing loss (right ear), hypertension, and severe dysplasia conditions, the panel recommends no change from the PEB determinations as not unfitting. 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.

PD-2017-03848 

AR20190010895, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX

	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.

	
PD-2017-03848