RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01664
BRANCH OF SERVICE:  NAVY 	BOARD DATE:  20150616
SEPARATION DATE:  20041229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Operation Specialist Third Class) medically separated for a left hip condition which could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.   He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The condition “left hip Perthe’s disease” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated the condition as unfitting, rated 10% (documenting a 0% deduction as a pre-existing condition), with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was not evaluated for his left knee condition.  His complete submission is at Exhibit A. 

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

IPEB - Dated 20040920	VA* (~ 2 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Perthe’s Disease	5299-5003**	10%	Aseptic Necrosis ... Left Hip	5099-5003	10%	20041104	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  10%	
*   Derived from VA Rating Decision (VARD) dated 20041104 (most proximate to date of separation [DOS]).  
** Presumed typographical error.  Correct VASRD analogous code prefix is 5099.

ANALYSIS SUMMARY:  

Left Hip Condition.   The CI’s enlistment physical in October 2001 was negative for hip complaints or findings, and the earliest service treatment record (STR) entries for left hip pain (no specific injury or precipitant) surfaced in mid-2003 (18 months pre-separation).  The pain persisted, and imaging yielded a “likely” diagnosis of hip Perthe’s disease (congenital dysplasia of the hip [femoral head]).  Orthopedics opined that surgical intervention was not indicated at the time, although a future joint replacement would likely be necessary.  The condition failed a trial of conservative treatment with activity limitations and maximum imposition of LIMDU.  Orthopedic entries documented painful hip motion with external rotation limited to 30 degrees (normal 45, minimum compensable 15) and flexion limited to 90 degrees (normal 125, minimum compensable 45).  There is no STR documentation of more significant range-of-motion (ROM) limitation, joint deformity or instability, gait disturbance, or periods of incapacitation.  The narrative summary (NARSUM) was conducted 16 August 2004 (4 months pre-separation) and documented “daily aching pain” prohibiting running and prolonged standing.  The NARSUM physical examination did not record gait or joint findings, but provided measured ROM of flexion to 110 degrees, external rotation to 20 degrees, and abduction to 35 degrees (normal 45, minimum compensable 10).  The commander’s non-medial assessment (NMA) stated “his condition has limited his ability to lift, stand or walk for more than 15 minutes ....”

A VA Compensation and Pension (C&P) examination was conducted 4 November 2004 (2 months pre-separation), and documented “constant chronic left hip pain ... [rated 4-5/10 with flares two to three times per week] ... [which] ... worsens with ... running ... walking more than an hour ... or when he has to lift anything that has any weight to it ....”  The VA physical examination recorded a normal gait, no significant leg length discrepancy and joint tenderness.  The VA measured ROM was flexion 110 degrees, extension 25 degrees, adduction 30 degrees (normal 45, minimum compensable “cannot cross legs [~10 degrees]), and external rotation 30 degrees; annotating painful motion. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to code 5003 (degenerative arthritis) was consistent with VASRD §4.71a criteria for that code, based on the service (and pre-separation VA) evidence.  The VA coded equivalently and stipulated painful motion (VASRD §4.59) to support its 10% rating.  The evidence does not support the minimum compensable rating (barring application of §4.59) under any of the codes for limitation of motion at the hip (5251, 5252, 5253).  The only potential route to a rating higher than 10% in this case is analogous application of code 5255 (femur, impairment of) which confers ratings for contiguous hip disability: 20% for “moderate” and 30% for “marked.”  However, members agreed that since code 5255 specifies complications of fractures, the objective disability in evidence does not justify the analogous stretch of its application in this case.  Gait and routine activities were not significantly affected, and the ROM limitations were modest.  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 of the left 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.  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 left hip 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131014, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Aug 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN