RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX CASE: PD1200390 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130321 

SEPARATION DATE: 20080414 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PV2/E-2 (Trainee) medically separated for coccydynia 
and overall effect of bilateral trochanteric bursitis and right Achilles tendonitis. Despite 
conservative treatment, the CI 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 
MEB conditions “coccygodynia,” “bilateral greater trochanteric bursitis” and “right Achilles 
tendonitis with retrocalcaneal bursitis” were forwarded as medically unacceptable to the 
Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the 
MEB. The PEB adjudicated “coccydynia” as unfitting and adjudicated overall effect (but not 
separately unfitting) of “bilateral trochanteric bursitis and right Achilles tendonitis,” rated 10% 
and 0%, referencing DoD Instructions and the Veterans Affairs Schedule for Rating Disabilities 
(VASRD). The CI made no appeals and was medically separated with a 10% combined disability 
rating. 

 

 

CI CONTENTION: “SEVERAL ITEMS WERE DEFFERED AT TIME OF DISCHARGE, VETERAN HAS 
SINCE BEEN GRANTED A RATING DECISION SIGNIFICANTLY HIGHER THAN THE 10% INITIALLY 
GIVEN AT TIME OF DISCHARGE.” 

 

 

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 by the PEB, but not determined to be 
unfitting, when specifically requested by the CI. The ratings for the unfitting coccydynia and the 
combined effect of the bilateral trochanteric bursitis and right Achilles tendonitis conditions are 
addressed below; 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 respective 
Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20080313 

VA - (12 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Coccydynia 

5299-5298 

10% 

Residuals of Coccyx Fx 

5299-5298 

10% 

20090429 

B Trochanteric Bursitis 
and R Achilles Tendonitis 
(Combined effect) 

4000 

0% 

Right Hip Bursitis 

5016-5252 

10% 

20090429 

Left Hip Bursitis 

5016-5252 

10% 

20090429 

R Achilles Tendonitis… 

5271-5284 

0% 

20100506 

No Additional MEB/PEB Entries 

Other x 15 

20090501 

Combined: 10% 

Combined: 70% 



Derived from VA Rating Decision (VARD) dated 20090519 and 20090501for deferred conditions 


 

ANALYSIS SUMMARY: The PEB utilized “Overall Effect” in the adjudication of this case IAW 
DoDI 1332.38, paragraph E3.P3.4.4., for the bilateral greater trochanteric bursitis and Achilles 
tendinitis conditions. The presumption in these cases is that none of these conditions was 
separately unfitting. Each condition is reviewed by the Board with application of the higher 
‘PEB not unfitting to Board unfitting’ threshold which requires a preponderance of evidence to 
overturn the PEB adjudication. If no individual condition is determined to be unfitting, a ‘no 
change’ recommendation is made. 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 Department of 
Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, 
operating under a different set of laws (Title 38, United States Code), is empowered to 
compensate all service-connected conditions and to periodically re-evaluate said conditions for 
the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary 
over time. The Board’s role is confined to the review of medical records and all evidence at 
hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based 
on severity at the time of separation. The Board utilizes DVA evidence proximal to separation 
in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special 
consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40, 
however, resides in evaluating the fairness of DES fitness determinations and rating decisions 
for disability at the time of separation. Post-separation evidence therefore is probative only to 
the extent that it reasonably reflects the disability and fitness implications at the time of 
separation. The Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to the CI’s statements in the application regarding suspected DES improprieties in 
the processing of her case. 

 

The CI first sought medical care for her right foot on 11 October 2007 while in basic training. 
She stated that her foot had hurt since someone stepped on it a week before. The examination 
and X-rays were normal and she treated with medications and duty limitations. She was seen 
again a week later. Again, the examination and X-rays were normal; she was referred to 
physical therapy (PT). A PT noted on 26 October 2007 documented a 5 week history of pain, 
but a normal gait without objective findings and also that she had not missed any required 
training. She continued to have pain, though, and was then given a splint. Magnetic resonance 
imaging (MRI) on 25 January 2008 was consistent with retro-Achilles tendinitis. She continued 
use of the cam boot with reduced symptoms and at her clinical visit on 12 March 2008, she had 
minimal tenderness on palpation of the plantar surface of the right foot and was tender to 
palpation of the heel. Dorsiflexion (which would stretch the Achilles tendon) was painful. The 
examination of the foot and ankle was otherwise normal. The 20 March 2008 orthopedic 
examination noted that the Achilles tendinitis was resolved and that she was pain free. She 
was noted to have normal strength and reflexes. No comment was made regarding tenderness. 
The CI had pelvic X-rays on 15 November 2007 which were consistent with bilateral stress 
fractures of the inferior pubic rami (IPR). There was no corresponding clinical note in evidence. 
On 20 November 2007, she was evaluated in PT and reported a 4 week history of left anterior 
groin pain. The gait was non-antalgic, but special maneuvers were consistent with the IPR 
stress fractures, symptomatic on the left. She responded well to conservative management and 
reported no pain with daily activities although she noted pain at night during a 4 December 
2007 PT appointment. She completed basic training and began advanced individual training 


(AIT) on 2 January 2008. She was seen on 4 January 2008 for a new profile and reported 10 out 
of 10 bilateral hip pain which did not respond to medications and was totally disabling. A 
history of trauma to either hip was specifically denied. On examination, the hip flexors were 
tender, but the trochanteric bursae were not. The range-of-motion (ROM) was normal, but 
painful. Sensation and strength were normal as were gait and stance. An X-ray that day was 
normal. A bone scan on 15 January 2008 was negative for pelvic stress fractures, but there was 
moderate uptake of the pubic symphysis, mild uptake in the mid coccyx consistent with prior 
trauma, moderate uptake at the insertion of the Achilles tendon bilaterally, and at the base of 
the first metatarsals. There was also generalized uptake in the knees, ankles, and feet. At a 
follow up on 15 January 2008, she was no longer symptomatic in the right hip, but the left hip 
remained tender and ROM was painful. The examination was otherwise unchanged. The 
trochanteric bursae were again specifically noted as non-tender. 23 January 2008 was the CI’s 
next appointment in PT. She reported that the hip pain was worse on the left and that she also 
had sacral pain. She also stated that she had jumped off of a military vehicle (five ton truck) on 
19 November 2007 and was diagnosed with bilateral IPR stress fractures. On examination, she 
had full active ROM of both legs including the left hip which was painful in all planes. An Ober 
test, for the iliotibial band, was positive but a FABER test, for hip or contralateral sacroiliac joint 
pathology, was negative. She was markedly tender over the pubic symphysis and left greater 
trochanteric area. On 29 January she reported that the pain continued and that she now had a 
severe painful sensation from her lower back which radiated to her upper and lower 
extremities. She was started on Gabapentin with improvement noted the next day. A 
neurology evaluation was normal and noted “multiple somatic pain complaints related to a 
minor injury during basic training.” An MRI of the cervical, thoracic, and lumbar spine, done on 
1 February for the low back pain (LBP) with radiation, was normal. The bilateral hip pain 
persisted despite PT and she was referred to Physical Medicine and Rehabilitation (PMR). At 
her first PMR appointment on 25 February 2008, she reported the pain began 19 November 
2007 when she fell 6-8 feet off of a five ton truck and landed forward on her weapon which 
then threw her backward causing her to land on her buttock. At that visit she reported 
continued back pain with radiation down the left leg and to the left shoulder and bilateral 
atrophy of the calves. On examination, she was noted to have tenderness over the greater 
trochanters bilaterally, tenderness of the piriformis muscle and over the iliotibial bands. The 
ROM was painful bilaterally. The neurological examination was normal and atrophy of the 
quadriceps and calves specifically noted as absent. She was given a steroid injection of the left 
greater trochanter with complete relief of symptoms on that side. At a PT appointment a few 
days later, she reported that her left hip pain was now worse after the injection, but still had 
full ROM with pain in the left hip in all planes of motion. She also reported that the LBP was 
increasing. The next day, she was again seen in PMR. She reported that the left hip pain was 
now resolved and underwent a steroid injection of the right trochanteric bursa. At a 17 March 
2008 PMR appointment, she reported that she had enjoyed complete pain relief for a week. 
She reported popping and locking of the hips and an MRI was ordered to evaluate for labral 
pathology. She stated that she had stopped PT due to worsening of her symptoms. On 
examination, she again had tenderness over both hip and painful motion in both hips. The 
sensory examination was abnormal with impaired pinprick over the dorsum of the right foot 
and medial right heel. Flexion of the hips was slightly reduced to 5-/5 secondary to pain. Her 
reflexes remained normal. The next day she was seen in PT and noted to have had no benefit 
from PT (per history). The hip ROM was again noted to be normal but painful on the left in all 
planes of motion. She was again very tender to palpation over the pubic symphysis and left 
greater trochanter. She was discharged from PT due to a failure to progress. The MRI of the 
hips was done that day and was normal bilaterally. No soft tissue masses or fluid collections, 
such as would be seen in an inflamed bursa, were noted. The labra were specifically noted as 
normal. Two days later, 20 March 2008, she was evaluated in orthopedics. She reported that 


 

Coccydynia Condition. The Board first considered the coccydynia condition. It noted that the 
condition was only discussed in context of the bilateral bursitis condition and not separately 
treated. An MRI of the whole spine was normal and a bone scan only showed mild uptake 
consistent with prior trauma. The Board observed that this condition is common in pregnancy 
and can persist afterwards; the CI delivered her first child eight months prior to accession. 
Coccydynia is also associated with trauma; however, the one and only mention of falling on her 
‘tailbone’ was found in the records at the orthopedic appointment accomplished less than 4 
weeks prior to separation. The contemporaneous records are silent for any injury related to 
either falling from or jumping off of a vehicle. The narrative summary (NARSUM) was dictated 
on 5 February 2008, 2 months prior to separation. It recorded that the CI jumped from a five 
ton vehicle while wearing her battle gear, lost her balance and struck her coccyx on the ground 
with the immediate onset of pain. She subsequently developed pain in her hips, left greater 
than right. On examination, she had point tenderness over the coccyx. She was able to rise on 
her heels and toes without difficulty although her gait was antalgic as she was still using the 
cam walker. The ROM of the lower back was normal as was the neurological examination. She 
was diagnosed with coccygodynia (an alternate term for coccydynia) which is a painful tailbone. 
The Board noted that this is a symptom rather than a diagnosis. At the VA Compensation and 
Pension (C&P) examination performed specifically for the coccyx on 6 May 2010, over 2 years 
after separation and well outside the 12 month window assigned a higher probative value, the 
CI reported that she had injured her coccyx in a fall in 2008. She had pain weekly to monthly 
associated with prolonged sitting. No comment was made on tenderness. Her gait was normal. 
The examiner noted that the MRI had not shown a fracture, but diagnosed a fracture of the 
coccyx nonetheless. The IPEB coded the coccydynia following a fall without fracture as 5299-
5298. She was rated as analogous to removal of the coccyx with painful residues at 10%. The 
VA also rated the condition at 10% and used the same code. The Board noted that although the 
PEB attributed the coccydynia to a fall in November 2007, contemporaneous records are silent 
for both this injury and pain in the coccyx. Also, there is no mention of coccydynia in the 
records in evidence until early February 2008, 4 months after the cited fall and 2 months prior 
to separation. The Board found no records indicating evaluation or treatment solely for the 
coccydynia in evidence. However, it is not the prerogative of the Board to either lower a 
condition or to render a condition fitting which has been determined to be unfitting by the PEB. 
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 coccydynia condition. 

 

Bilateral Trochanteric Bursitis and Right Achilles Tendonitis Condition. The PEB determined that 
neither condition was separately unfitting and rating them at 0% disability for combined effect. 
The Board noted that the final PMR examination, a week prior to separation, documented that 
the right hip was pain free (over 2 weeks after an injection) and that the left hip had minimal 
pain rated at 3 out of 10. An orthopedic examination 2 weeks earlier and 3 weeks prior to 


separation documented resolution of the right Achilles tendinitis and improvement in her left 
greater trochanteric bursitis to the point that the right side was now more symptomatic. Pelvic 
X-rays were negative and an MRI was also negative for soft tissue pathology of the hips. A bone 
scan had shown uptake at numerous sites, but not the bursae. The NARSUM was prior to the 
above examinations and 2 months prior to separation. She was still in the cam walker for her 
right Achilles tendinitis and demonstrated left greater than right hip pain. The ROM for both 
hips was noted to be reduced in contrast to numerous PT appointments at which a normal 
ROM was observed for both hips. At the C&P examination performed specifically for the coccyx 
on 29 April 2009, over a year after separation, the CI reported continued pain and had reduced 
and painful ROM on examination. The Board first considered the combined effect adjudication 
of the PEB. It noted that the ROM of the hips measured at multiple PT appointments was 
normal although painful on the left. The orthopedic examination 3 weeks prior to separation 
documented resolution of the Achilles tendinitis, the expected outcome. The final PMR note 
was written a week prior to separation. It documented minimal pain of the left greater 
trochanteric bursa and no pain on the right. The Board noted that there had been an injection 
on the right, but almost 3 weeks earlier. The preponderance of evidence is that the CI was 
responding well to treatment at the time of separation. The Board noted that the mere 
presence of symptoms is not sufficient to render a condition unfitting and that the CI actually 
continued to improve after the IPEB adjudication. 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 bilateral greater 
trochanteric bursitis and right Achilles tendinitis conditions. 

 

 

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 coccydynia, bilateral greater trochanteric bursitis, and 
right Achilles tendinitis conditions 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 

Coccydynia 

5299-5298 

10% 

Overall Effect of Bilateral Trochanteric Bursitis and Right Achilles 
Tendonitis 

N/A (4000) 

0% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120427, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 


 

 

 

 xxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxxx, AR20130008757 (PD201200390) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)