RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01541
BRANCH OF SERVICE:  Army	BOARD DATE:  20141119
SEPARATION DATE:  20041015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army SGT/E-5 (31B20/Military Police) medically separated for a low back and left hip condition.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate event to satisfy physical fitness standards.  He was issued a permanent L3/E2 profile and referred for a Medical Evaluation Board (MEB).  The low back and left hip conditions, characterized as “left hip: chronic trochanteric bursitis” and “chronic low back pain” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded six other conditions (pes planus, recurrent herpes simplex, uncorrected vision, migraine headaches, heart-burn and wrist tendinitis) for PEB adjudication.  The Informal PEB adjudicated “chronic low back pain secondary to existed prior to service (EPTS) injury, permanently service aggravated by subsequent injury” and “chronic left hip pain, permanently service aggravated by subsequent injury,” as unfitting, rated at 10% and 0% respectively.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Lower Back Pain Which Was Noted, Has Not Been Compensated”

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 ratings for the unfitting low back pain and left hip 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 Board for Correction of Military Records.

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.

RATING COMPARISON:

Service IPEB – Dated 20040617	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain Secondary to EPTS Injury, Permanently Service Aggravated 	5237	10%	Low Back Pain	5243	10%	STR	
			Left Lower Extremity Radiculopathy Associated with Low Back Pain	8520	10%	STR	
Chronic Left Hip Pain	5019	0%	Left Hip Trochanteric Bursitis	5019-5252	0%	STR	
Other x 6  (Not in Scope)	Other x 4 		
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050118 (most proximate to date of separation)

ANALYSIS SUMMARY:

Chronic Low Back Condition.  Treatment records documented that the CI first presented with intermittent low back pain (LBP) in February 1999.  There was no history of recent trauma or prior back injury.  He was diagnosed with mechanical LBP without radiculopathy and treated with activity modification and medications.  The records were silent for LBP until August 2000 when the CI was involved in a motor vehicle accident (MVA).  At that time he reported dull to sharp LBP rated 5/10 to 6/10.  Despite physical therapy and pain medications, the CI continued to report persistent LBP.

The narrative summary (NARSUM) on 1 June 2004 noted the CI sustained a back injury prior to service and a MVA with recurrence of LBP (2000).  The CI reported civilian chiropractic care after the MVA.  At the MEB NARSUM examination, the CI complained of constant pain in the lower back; aggravated by standing and sitting more than 30 minutes, repeated bending, heavy lifting, direct pressure to back and impact activities.  The lumbosacral examination was significant for painful motion (forward flexion of 90 degrees, extension of 30 degrees and combined motion greater than 120 degrees) and decreased sensation in the left lower extremity along the outer thigh to the lateral foot consistent with S1 nerve root dysfunction, but motor strength was normal.  The examiner rendered a diagnosis of chronic LBP.  The CI was a “no-show” for his VA Compensation and Pension (C&P) examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic LBP as unfitting with notation that the condition EPTS and was permanently aggravated.  The PEB and VA relied on the MEB examination and both assigned a 10% disability rating for the LBP condition.  The Board considered whether there was evidence for a rating higher than 10%.  There was no evidence of  forward flexion of the thoracolumbar spine less than 60 degrees; combined range-of-motion (ROM) of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis for a 20% rating.  There was no evidence of an unfitting radiculopathy for an additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain condition.

Chronic Left Hip Condition.  The CI sustained a left hip injury prior to entry into service and experienced recurrence of pain after an MVA in 2000.  At an orthopedic evaluation for “excruciating left hip pain,” the examiner noted tenderness to palpation of the left greater trochanteric area (outer side of the left hip) with slight restriction of internal rotation motion.  A diagnosis of “probable trochanteric bursitis” was rendered with recommendations for a bone scan and physical therapy.  The CI underwent a course of physical therapy for trochanteric bursitis and illiotibial band (IT) irritation, but continued to report left hip pain.  X-ray evaluation dated 26 February 2004 was normal.  A magnetic resonance imaging on 5 April 2005 revealed mild greater trochanteric bursitis.

At the orthopedic MEB evaluation dated 21 May 2004, the CI reported after walking a half mile he would begin to have hip pain which required him to sit for relief.  He could only run 50 feet, stand for 10 minutes per hour and sit for five to ten minutes due to hip pain.  The physical examination noted ROM limited to 110 degrees of flexion, 45 degrees of abduction, 10 degrees internal rotation and 45 degrees external rotation.  Diagnoses of left hip pain with greater trochanteric bursitis and mild SI joint arthrosis were rendered.

The NARSUM dated 1 June 2004 noted the CI underwent a series of injections for his left hip bursitis with good relief, but the left hip pain returned with use of his pistol belt.  At the time of the examination the CI reported constant left hip pain.  The physical examination was significant for tenderness to pressure in the left hip over the greater trochanter with pain limitation of abduction to 30 degrees.  Abduction was normal on the right. He was able to cross his legs without difficulty.  A diagnosis of chronic trochanteric bursitis was rendered.  The CI was a “no-show” for the VA C&P examination.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic left hip pain as unfitting with a Service disability rating of 0% for no loss of hip motion.  The VA rated the left hip trochanteric bursitis at 0% citing a non-compensable evaluation was assigned by the PEB and other VASRD compensable criteria were not evident at the time NARSUM examination.  The CI did not show for his VA examination, therefore, his VA rating was based on medical records and examinations most proximate to separation.  The Board considered treatment records, the NARSUM examination and the orthopedic MEB consultation all documented reported pain with use and objective findings of left hip pain.  There was also radiographic evidence of left trochanteric bursitis.  Although there is no compensable limitation of hip motion, VASRD § 4.59, painful motion recognizes painful motion with peri-articular pathology as productive of disability and entitled to at least the minimum compensable rating for the joint.  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 left hip chronic trochanteric bursitis 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 LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left hip chronic trochanteric bursitis condition, the Board unanimously recommends a disability rating of 10%, coded 5019 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 his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Low back pain Condition	5237	10%	
Left hip chronic trochanteric bursitis condition	5019	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130920, 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, AR20150006341 (PD201301541)

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 20% 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