RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02405
BRANCH OF SERVICE:  Army	BOARD DATE:  20140617
SEPARATION DATE:  20041126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (Basic Trainee) medically separated for groin condition.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The groin condition, characterized as “left inferior pubic ramus stress fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  One other condition was submitted by the MEB.  The Informal PEB adjudicated chronic left groin pain secondary to inferior pubic ramus stress fracture condition as unfitting, rated 0%, with application of VA Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “I am still having pain in the area.”

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 groin condition is addressed below.  The not unfitting feet condition was not contended and, thus is not within the DoDI 6040.44 defined purview of the Board.  This, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected conditions continue to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence within 12 months only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20041103	VA* - (13 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Groin Pain Secondary to Inferior Pubic Ramus Stress Fracture	5099-5003	0%	Inferior Pubic Ramus	5294	NSC	20051221	
			Chronic Left Groin	5299-5294	NSC	20051221	
Other x 0 (Not in Scope)	Other x 3	20051221	
Combined:  0%	Combined:  NSC	
*Derived from VA Rating Decision (VARD) dated 20060202. 

ANALYSIS SUMMARY:

Chronic Left Groin Pain Secondary to Inferior Pubic Ramus Stress Fracture.  The service treatment record (STR) indicated that the CI, while in basic training, experienced a greater than ten foot fall (upon backside/buttock) that caused pain to her left pelvic area.  Initial X-rays were reported as normal and she was conservatively treated for a hip sprain.  Serial X-rays eventually revealed a “healing stress fracture” of the left inferior pubic ramus (deep lower groin area).  There were no additional boney abnormalities noted in either leg.  Despite a variety of physical therapy (PT) modalities, her pelvic pain persisted and was aggravated with activity.  At the MEB narrative summary (NARSUM) performed on 20 October 2004 (5 weeks prior to date of separation [DOS]) she endorsed continued left groin pain (2-5 out of 10 in intensity) aggravated by prolonged sitting/standing, running, marching or climbing stairs.  The physical examination revealed lower left groin tenderness with painful motion of the left hip.  Her gait was antalgic.  Prior PT measured hip range-of-motion (ROM) (7 weeks prior to NARSUM) indicated full, but painful motion.  Her diagnosis remained left inferior pubic ramus stress fracture presently stable with a prognosis of, “…is expected to totally and completely heal from this injury.”  There was no comment crepitus, or guarding.  There was no commander’s letter or statement provided as for the CI being in basic training.  On a “report of medical assessment” dated 5 October 2004, the CI answered “No” to the question of, “Do you have any condition which currently limits your ability to work in your primary military specialty.”  At the VA Compensation and Pension (C&P) examination performed on 21 December 2005 (13 months after separation), the CI reported intermittent pelvic and groin pain described as sharp, burning and cramping.  Occurrence was 3-4 times per week each lasting for “48 hours.”  Aggravating factors include prolonged sitting/standing, moving about, and lifting over 20 pounds.  She states her condition does not cause incapacitation.  Her VA physical examination was limited and revealed decreased and painful ROM of the left hip.  Her flexion was 58 degrees, extension 8 degrees, abduction 32 degrees and adduction 16 degrees.  Despite the limited and painful motion, the VA examiner had no diagnosis due to “there is no pathology [present] to render a diagnosis” in regards to the claimed status post left hip stress fracture.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated 0% analogously to 5003 (degenerative arthritis) whereas the VA reported not service-connected to both the left groin pain and pubic bone stress fracture citing the absence of treatment and diagnosis occurring while in Service.  Board members first agreed that the MEB NARSUM had higher probative value as its close time-proximity to the CI’s DOS as compared to the remote VA examination.  Member’s then agreed that sufficient evidence of painful motion was present at the MEB and throughout the STR to justify a minimum 10% rating IAW VASRD §4.59.  Although hip ROM was decreased, there were no ROM limitation in evidence which met minimal criteria of the relevant codes 5251, 5252 or 5253 (limited hip extension/flexion and impairment); and, there were no other  available alternative joint or analogous coding options which were applicable and or advantageous to rating.  In the absence of incapacitating episodes, members agreed that a rating higher than 10% (§4.59) was not supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10%, coded 5099-5003 for the left groin pain secondary to inferior pubic ramus 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 left groin pain condition, the Board unanimously recommends a disability rating of 10% coded 5099-5003 IAW VASRD §4.59.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Groin Pain due to Pubic Rami Stress Fracture	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130111, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150002637 (PD201302405)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA