RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	 CASE:  PD 13-01436	
BRANCH OF SERVICE:  Army	 BOARD DATE:  20140115
SEPARATION DATE:  20041118		 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (19D/Scout) medically separated for bilateral hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral hip pain condition, characterized as “medically unacceptable”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The informal PEB adjudicated “bilateral hip pain” as unfitting, rated 0%.  The CI made no appeals, and was medically separated.  

CI CONTENTION:  “Pains in legs starting from waist down at certain positions if held. (Driving, laying, crossing legs, sleeping on back and others).

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 Service rating for the unfitting bilateral hip pain 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 Army Board for Correction of Military Records (BCMR). 

RATING COMPARISON:  
   
Service IPEB – Dated 20041026	VA – 20050128 Decision based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	0%	Left Femoral Neck Fracture	5255	0%	STR	
			Right Femoral Neck Fracture	5255	0%	STR	
No Additional MEB/PEB Entries	 	 	
Combined:  0%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20050128 (most proximate to date of separation [DOS]).  The initial VA examination was on 20060208.  There was no rating change until 20090515 which was effective 20090116

ANALYSIS SUMMARY:  

Bilateral Hip Pain Condition. The CI was evaluated in the emergency room on 9 August 2004, two months after accession on 2 June 04 and while in basic training, with a two day history of right groin pain.  He was seen three days later and noted to have a right femoral neck fracture.  He was referred to orthopedics and admitted for surgery.  The fracture was pinned that day.  During the post-operative recovery, he sustained a left femoral neck fracture while using crutches to keep the right hip non weight bearing (NWB.)  He was then confined to a wheelchair for six weeks.  The narrative summary (NARSUM) was dictated on 24 September 2004, six weeks after surgery and less than two months prior to separation.  The examiner noted that the CI denied pain and used no medications.  The fractures had healed and he ambulated without difficulty.  On examination, the incisions were well healed on the right side.  He had full range of motion (ROM) of the hips and normal strength.  There were no neurological symptoms and the joints were stable.  X-rays showed callous formation about both fracture sites (indicative of healing) and well placed screws on the right.  He was thought to be stable with an excellent prognosis, but to be at increased risk for a repeat fracture in the military training environment.  He was referred to the PEB for disposition.  At the VA Compensation and Pension (C&P) examination performed 15 months after separation, the CI reported that he had discomfort in his hips with weather changes and occasionally had pain at night.  He reported that he could drive no longer than 45 minutes or walk longer than 15 minutes.  He was working full time for a tree trimming service and had not missed any work secondary to his hips.  He did not use medications or an assistive device.  His gait was normal.  Flexion of the right hip was reduced 14 degrees from the VA normal value of 125.  The left was normal.  Extension was limited to 0 degrees bilaterally (normal 20), and external rotation to 30 degrees bilaterally (normal 45).  Values for abduction and adduction were not annotated.  Strength was normal.  X-rays were normal other than the presence of the surgical pins on the right.  He was thought to have healed with some residual discomfort.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the hips at 0% each based on the service treatment records, but coded the condition, respectively, 5099-5003, analogous to degenerative arthritis, and 5255, impairment of the femur.  In addition, the VA rated each hip separately whereas the PEB rated the hips as a combined condition.  The VA examination 15 months after separation was outside the 12 month window of higher probative value for rating determination.  The VA subsequently raised the right hip to 10% due to an inability to cross his right leg based on the 16 January 2009 examination and effective that same day.  This was over four years after separation and well outside the normal 12 month window assigned higher probative value.  The MEB examination was proximate to separation and showed an excellent recovery from the stress fractures and surgery.  The CI had normal ROM and strength and was pain free off of medications.  The Board considered if each hip was separately unfitting.  It noted that the profile was for bilateral hip pain, that there were bilateral stress fractures although only the right required surgery, and that the commander cited both hips.  The Board determined that the evidence supports finding each hip as separately unfitting even though the right hip was the more problematic.  However, the Board found no route to a rating higher than the 0% assigned for the hip pain by both the PEB and VA.  It observed that rating each hip separately at 0% provides no advantage to the CI.  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 hip 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 bilateral hip pain condition 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	
Bilateral Hip Pain s/p Bilateral Stress Fractures	5099-5003	0%	
COMBINED	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20140005219 (PD201301436)

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