RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX CASE: PD1201711 BRANCH OF SERVICE: ARMY BOARD DATE: 20130227 SEPARATION DATE: 20020709 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve PFC/E-3 (37F10/Psychological Operations Specialist) medically separated for stress fracture of the inferior pubic ramus. Thirty days after beginning basic training she developed pain in the left side of her lower back and right side of her pelvis and was diagnosed with an inferior pubic ramus stress fracture. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left inferior pubic ramus fracture, mechanical lower back pain and left retropatellar pain syndrome conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated the stress fracture of the inferior pubic ramus as unfitting, rated 0% and the remaining conditions were determined to be not unfitting and therefore not ratable. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: The CI elaborated no specific contention in her application. SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting stress fracture of the inferior pubic ramus condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board of Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20020613 VA - (3 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Stress Fx of Inferior Pubic Ramus 5099- 5022 0% Residuals Stress Fx of Lt Pubis 5099- 5022 0% 20021011 Mechanical Low Back Pain Not Unfitting Lumbosacral Strain 5295 0%* 20021011 Lt Retropatellar Pain Syndrome Not Unfitting Patellofemoral Syndrome Lt Knee 5260 0%* 20021011 No Additional MEB/PEB Entries Other x 0 20021011 Combined: 0% Combined: 0% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the VA but not determined to be unfitting by the PEB. Stress Fracture of Inferior Pubic Ramus Condition. The CI developed pain in the lower right pelvis area during basic training. Initial X-rays revealed no pathology. After continued pain with activity, a bone scan was obtained revealing a stress fracture of the right inferior pelvic ramus (sitting bone). The CI was appropriately treated with a 5 month trial of decreased activity with unsustained improvement. At the MEB/narrative summary (NARSUM) evaluation on 8 April 2002, 3 months prior to separation, the CI reported continued pelvic pain while running. She noted no bowel or bladder difficulties. On physical examination mild tenderness to palpation was present in right pelvic ramus area. Range-of-motion (ROM) of the hip and right leg was full with slight pain at extremes of motion. Motor strength was normal. At the VA Compensation and Pension (C&P) evaluation on 11 October 2002, 3 months after separation, the CI reported the ability to function normally without restriction and to be working full time and attending college. On physical examination there was no tenderness over the pelvic bones. Gait, to include squatting, was normal. The examiner noted “no residuals of the pelvic fracture on today’s examination.” The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the pelvic fracture condition 0% coded 5022, Periostitis. Rating level under this code is determined by limitation of motion. The Board considered rating under hip codes 5251, 5252, 5253 and 5254, but was unable to recommend a higher rating given the record in evidence. The Board unanimously agreed the condition did not rise to the level of minimal compensation under VASRD §4.59. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the pelvic stress fracture condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the pelvic stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Stress Fracture of Inferior Pubic Ramus 5099-5022 0% COMBINED 0% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120717, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20130005522 (PD201201711) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)