RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-00455
BRANCH OF SERVICE:  Army	BOARD DATE:  20140910
SEPARATION DATE:  20040226

SUMMARY OF CASE:  Data extracted from the available evidence of records reflects that this covered individual (CI) was an active duty SPC/E-4 (63B10/Light Wheeled Vehicle Mechanic) medically separated for a hip condition.  This condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3/S1 profile and referred for a Medical Evaluation Board (MEB).  Persistent pain from hip stress and marfanoid habitus with overuse hip arthraglias conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated right hip pain as unfitting, rated 0%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Still have problems with both hips, to include pain during pregnancies and births, cannot jog or run (continue) Sometime need to use a cane.  PTSD is still hard-jumpy.  Sit with back to wall, defensive, MST has caused a divorce and maybe my current marriage due to intimacy and trust issues.  Severely afraid of men.  Will not even be in an elevator or small space with a male alone.  Sacred all the time.  Sleeping problems, fear of the dark, fear someone will injury my children.  Alcoholism, which is severe.  Getting help.”

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 hip condition is addressed below along with the contended mental health condition.  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 (DES) 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, operating under a different set of laws.

In additionally, the CI was notified by the Department of the Army that, members diagnosed with mental health (MH) condition(s) that were referred to the DES process between 11 September 2001 through 30 April 2012 and whose MH diagnoses were changed during the DES process, may be eligible for a comprehensive review, IAW Department of Defense Directive.

RATING COMPARISON:

Service IPEB – Dated 20031126	VA* - (~2.7 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	0%	Right Hip Stress Reaction	5299-5255	10%	20031208	
Mental Health Condition	Not Adjudicated	No VA Entry	20031208	
Other x 0 (Not in Scope)	Other x 6 (Not in Scope)	20031208	
Combined:  0%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20040326 (most proximate to date of separation)

ANALYSIS SUMMARY:

Right Hip Pain.  The narrative summary (NARSUM) dated 1 August 2003 (approximately 6 months prior to separation), noted the CI initially presented to sick call in August 2002 with onset of hip pain after advanced individual; pain greater in right hip than left hip.  The CI was initially treated conservatively with acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs.  Due to persisted hip pain the CI underwent a bone scan in September 2002 that revealed stress reaction of bilateral hip.  Repeat bone scan in January 2003 noted mild persistent stress reactions in hips with interval development of mild bilateral sacroilitis.  Radiographic study of the pelvis dated 24 June 2003, demonstrated normal and symmetric hip joints bilaterally, with no evidence of joint effusion or arthritic changes; overall normal pelvis and bilateral hip.  

X-rays images of bilateral hip obtained in July 2003, revealed no evidence indicative of sacroilitis.  The NARSUM noted a CT scan showed no evidence of joint space narrowing, sclerosis, erosions or blastic or lytic processes.  On physical examination, the examiner noted an antalgic gait to the right side and tenderness to palpation of the right superior trochanter.  Range-of-motion (ROM) was not recorded.  The examiner diagnosed persistent pain of hip, stress reactions and marfanoid habitus, with overuse hip arthraglias.  The MEB physical therapy report dated 4 December 2003 (2 months prior to separation), recorded a right hip ROM of 110 degrees (normal 120) and a 5 degrees loss of motion after five repetitions (105 degrees).  Measurements of extension were normal with no change with repetition.  There was painful motion noted during right hip ROM testing but none during the left hip.

The VA Compensation and Pension examination on 8 December 2003 recorded normal posture and gait.  The examiner noted the CI’s hip pain began 6 months after entering service and that at that time the right hip pain was greater than the left hip after prolonged sitting, standing or walking more than a mile.  The CI was able to walk on her toes, heels and tandem walk.  The CI stated since she stopped running, the hip pain had somewhat improved.  ROM of the right hip reflected those of the MEB’s physical therapy  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated right hip pain condition at 0%, coded analogously 5003 (arthritis).  The VA granted a 10% rating for each hip, coded analogously as 5299-5255 (femur, impairment) for a diagnosed of left and right hip stress reaction.  Following a detailed discussion of the evidence, the Board concluded that the right hip condition was not compensation under any ROM codes, but that there was ample evidence to support application of §4.59 (painful motion) to achieve a minimal compensable rating under VARSD 5099-5003.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a rating of 10% for the right hip pain condition.

Contended PEB Conditions.  The Board reviewed the records for evidence of inappropriate changes in diagnosis of the mental health conditions during processing through the DES.  There was no evidence of visits to the emergency room for MH issues, no report of suicidal or homicidal ideations, no psychiatric hospitalizations, violence or legal issues.  No MH condition was ever profiled or judged to fail retention standards.  There was no performance based evidence from the record that any MH condition significantly interfered with satisfactory duty performance.  The evidence of the available records showed the diagnosis of depression was recorded on the MEB DD Form 2808 (history and physical); however, there were no further supporting documentation in the available evidence other than the above stated that was review by the Board.  

Therefore, the Board determined that no MH diagnosis had been changed or eliminated to the CI’s possible disadvantage during DES process.  This CI therefore does not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.  The condition was reviewed by the action officer and considered by the Board.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability ratings are recommended.

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 hip condition, the Board unanimously recommends a disability rating of 10%, coded analogously 5003 IAW VASRD §4.59.  In the matter of the contended MH condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 Hip Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

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, AR20150002615 (PD201300455)

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						     

CF: 
(  ) DoD PDBR
(  ) DVA