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AF | PDBR | CY2014 | PD-2014-01698
Original file (PD-2014-01698.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2014-01698
BRANCH OF SERVICE: Army  BOARD DATE: 20140709
SEPARATION DATE: 20050405


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (88M/Motor Transport Operator/Initial Entry Trainee) medically separated for right inferior pubic ramus stress fracture condition. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right inferior pubic ramus stress fracture condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated the right inferior pubic ramus stress fracture condition as unfitting, rated 0%. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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 right inferior pubic ramus condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20050321
 VA* - (4.3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Inferior Pubic Ramus Stress Fracture 5099-5003 0% Residuals, Right Pelvis Stress Fracture w/ Lumbosacral Strain 5299-5236 20% 20050811
Other x 0 (Not in Scope)
 Other x 0 20050811
Rating: 0%
 Rating: 20%
*Derived from VA Rating Decision (VARD) dated 200 50920 (most proximate to date of separation (DOS))


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Right Inferior Pubic Ramus Stress Fracture Condition. The CI first presented for medical care of right hip pain in October 2004 while in basic training. X-rays in November detected a healing stress fracture of the right inferior pubic ramus, but despite physical therapy and 6 weeks of convalescent leave, activity-limiting pain persisted. At a physical therapy visit on 21 January 2005 (2.5 months prior to separation) the CI reported that she engaged in normal activities of daily living. Pain severity at rest was 3 on a scale from 0-10 and increased to 3-4/10 with movement. Gait was normal and a full squat was performed. Hip area pain was not evident during ambulation and ambulation was considered “not limited.” Tenderness was present in the area of the right pelvic girdle. The MEB separation physical exam (DD Form 2808) on 25 January 2005 showed a “slightly antalgic” gait and tenderness of the pelvis. At the narrative summary evaluation on 1 March 2005 (a month prior to separation), the CI reported right hip and groin pain that averaged 5/10 in severity, but increased to 6-7/10 with prolonged walking. Physical exam (performed on 14 February 2005) reported a “non-antalgic” gait.

At the VA Compensation and Pension (C&P) exam 4 months after separation, the CI complained of continued right groin pain that radiated to her right hip and lower back. Pain was constant, and worsened if she attempted to run or walk for more than a few steps. Physical exam showed an antalgic gait. Muscle spasm was present in the lumbar region. The examiner reported that recent radiographs of the hip were initially interpreted as normal, but an orthopedist on 8 July 2005 thought there was evidence of a radiographically healing pubic ramus stress fracture. The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

“
Right Hip (Thigh) ROM
(Degrees)
 NARUM 1 Mo. Pre-Sep VA C&P 4 Mo s . Post-Sep
Flexion (125 Normal)
Full Range of Motion” 125
Extension (20)
 20 ( 30 )
External Rotation (45)
 45 ( 60 )
Abduction (0-45)
 45
Adduction (45)
 25
Comment
 +Tenderness +Painful motion
§4.71a Rating
 10%* ( PEB 0% ) 10%* ( VA 20% )
*Conceding §4.59 (Painful motion)

The Board directs attention to its rating recommendation based on the above evidence. The PEB cited “no significant reduction in joint motion” in a rationale for a 0% rating. The VA assigned a 20% rating under an analogous 5236 code (sacroiliac injury and weakness) on the basis of groin pain and muscle spasm presumably causing decreased thoracolumbar ROM and an abnormal gait and spinal contour. While a compensable rating under the 5251, 5252 or 5253 codes was not justified because limitation of hip motion was not present, Board members agreed that there was sufficient evidence of painful motion IAW VASRD §4.59 to warrant a 10% rating using the PEB's coding pathway. The VA’s coding approach was considered. Despite the fact that the C&P examiner did not note the presence of groin muscle spasm, the Board concluded that assigning a spine code for an inferior pubic ramus stress fracture was a poor clinical fit and that IAW VASRD §4.67, a hip coding pathway was correct. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right 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. In the matter of the right inferior pubic ramus stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. 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
Right Inferior Pubic Ramus Stress Fracture 5099-5003 10%
RATING
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140415, 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 , AR20150006334 (PD201401698)
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

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