RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01756
BRANCH OF SERVICE:  Army	BOARD DATE:  20150108
Separation Date:  20041209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92G/Food Service Specialist) medically separated for left hip pain.  The left hip pain condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left hip pain condition, characterized as “left hip pain secondary to hip flexion strain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left hip pain status post (s/p) injury in Aug 04” as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Was told I should heal in time, but I haven’t.  I suffer from pain in my hip that radiates down to my foot, left side of my body.  I have trouble standing long periods and cannot cross my legs.  Running is out of the question.  I wish this wasn’t so, but they haven’t considered any change in my rating.  Also my stress fractures are the… [Unreadable]” [sic]

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 left hip pain condition is addressed below.  The contended stress fractures were not mentioned by the MEB or PEB and are therefore not within the Board’s scope.  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.

RATING COMPARISON:

Service IPEB – Dated 20041122	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5022	0%	s/p Flexor Strain; Left Hip	5399-5314	10%*	STR	
Other x0	Other x0	
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20041222 (most proximate to date of separation [DOS])
*In 2014, the VA added 3 additional conditions related to the left hip; however, the 10% combined rating stayed the same

ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that 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.  The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Left Hip Pain S/P Injury Condition.  The CI developed left hip pain after he tripped and hyperextended his hip during a road march after his third week of training.  The CI was evaluated in medical clinic for left side pain, which included his hip, knee, and ankle.  The physical exam findings were left hip pain with compression and heel strike.  The examiner ordered crutches, no weight bearing, and X-rays.  A bone scan demonstrated stress reaction in the left hip (source document not in the evidence present for review).  Left hip X-rays were normal.  The CI was placed on a 30-day convalescent leave to rest the left hip.  The orthopedist noted left hip flexor strain with improvement after convalescent leave; however, the CI reported continued left hip pain with running.  The physical exam findings were pain with left hip internal rotation and flexion, and tenderness to palpation (TTP) over the anterior aspect of the left hip flexor.  The examiner diagnosed unresolved left hip flexor strain.  The MEB narrative summary (NARSUM) exam documented that the CI was unable to return to training due to hip pain.  The examiner noted that the CI could not perform his duties due to his inability to stand for prolonged periods or carry heavy weights.  The examiner opined that the CI was compliant with his treatment and that his prognosis for further recovery as a civilian was excellent.  The physical exam findings were mild antalgic gait, full active range-of-motion (ROM) of the hip, strength was normal; however, there was TTP over the hip flexors and pain with flexion over the anterior flexor area.  The examiner noted that the CI’s pain rating was minimal and frequent.  The commander’s statement noted that the CI had been diagnosed with a stress fracture, which limited his participation in any further training.  The primary care examiner noted unresolved left hip pain with physical exam findings of mild antalgic gait, 90% squat with minor pain, TTP over the left inguinal ligament and proximal hip flexors.  The examiner diagnosed left hip flexor tendonitis.  The orthopedist noted a significant increase in the CI’s left hip pain with increased pain on weight bearing and with running.  The examiner diagnosed rule out femoral neck stress fracture and ordered more X-rays and a strict profile.  The orthopedist 3 days later noted that the bone scan was normal; however the CI still reported that his pain had worsened.  The orthopedists then recommended that the MEB process be continued.  There was no VA Compensation and Pension exam completed.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the left hip pain s/p injury condition as 5022 (periostitis) and rated at 0%.  The VA coded the s/p flexor strain; left hip condition as 5399 analogous to 5314 (Group XIV Function) and rated at 10% consistent with “moderate.”  The VA based their rating on the evidence from the STR.  All exams accomplished proximate to separation documented painful motion with activities.  The NARSUM examination and STRs warrant application of VASRD §4.59 (painful motion) and §4.40 (functional loss) to achieve the minimal compensable rating (10%).  There is no compensable ROM impairment under either the 5251 (limitation of extension) or 5252 (limitation of flexion) codes.  The Board considered code 5253 (thigh, impairment); but, loss of motion beyond 10 degrees abduction was not documented and this was the only route to a rating higher than 10% under that code.  The Board considered using codes 5399-5314; however, members agreed that code 5022 more aptly described the condition.  Thus, there is no route to a rating higher than 10% under any applicable joint code and no coexistent pathology, which would merit additional rating for the hip condition under a separate code.  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 pain 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 s/p injury condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5022 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	
Left Hip Pain s/p Injury	5099-5022	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20041225, 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, AR20150007434 (PD201301756)

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:

CF: 
(  ) DoD PDBR
(  ) DVA