RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01220
BRANCH OF SERVICE:  Army	BOARD DATE:  20140528
SEPARATION DATE:  20040827

SUMMARY OF CASE:  The available evidence of record indicates this covered individual (CI) was an activated National Guard PV1/E-1 (91E00/Dental Lab Specialist) on a temporary tour of active duty who was medically separated for a right hip condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or physical fitness standards, so he was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The hip condition, characterized as “right hip pain secondary to femoral neck stress fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501, with no other conditions submitted by the MEB.  The PEB adjudicated “chronic right hip pain…” as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I still find it difficult to perform my work duties or just daily activity without suffering pain and discomfort in my right hip.”

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; 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 Board for Correction of Military Records.

The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden him but notes 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, operating under a different set of laws.

RATING COMPARISON:

Service PEB – Dated 20040805	VA - (based on Service Treatment Records (STR))	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain…	5022	0%	Status Post Stress Fracture Right Femoral Neck	5299-5255	10%	STR	
No Additional MEB/PEB Entries	Other x 0		
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20040913.

ANALYSIS SUMMARY:

Right Hip Condition.  The narrative summary dated 18 June 2004 noted insidious onset of right hip pain (without specific trauma) and a bone scan consistent with a Grade II femoral neck stress fracture and a normal plain X-ray (source scan report not in evidence).  The CI’s hip pain had resumed after 30 days of convalescent leave, and he could not return to running.  The right hip exam indicated “There is a full active range of motion with increased pain with internal rotation.”  Strength, neurovascular and pelvic rock test and gait were all normal.  Orthopedic exam from July 2004 also indicated full active range-of-motion (ROM) with painful internal rotation.  There was no VA exam proximate to separation.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the right hip at 0% coded 5022 (Periostitis).  The VA, using the service treatment record, coded the right hip 5299-5255 (analogous to femur, impairment) and rated it 10% for slight hip disability.  All hip exams in evidence proximate to separation indicated pain with motion, without limitation in the active ROM.  Although there was no specific PEB reference to the USAPDA pain policy in effect at the time, it was likely applied to achieve a 0% rating.  VASRD compliant rating using the PEB coding of 5022 would be at 10% with consideration of VASRD §4.59, painful motion.  However, alternative coding under 5299-5255 at 10% was adjudged as a better coding fit since it was more specific to the CI’s specific hip condition.  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 hip 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.  As noted above, PEB reliance on the USAPDA pain policy for rating the right hip condition was likely operant in this case; the condition was adjudicated independently of that policy by the Board.  In the matter of the right hip condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5255 IAW VASRD §4.71a.  No other conditions were within the Board’s scope of review.

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

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Hip Pain …	5299-5255	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130909, 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 XXXXXXXXXXXXXXX, AR20140021568 (PD201301220)

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