RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01885
BRANCH OF SERVICE: Army	BOARD DATE:  20140520
SEPARATION DATE:  20041110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (Trainee) medically separated for left hip pain.  The CI developed hip pain during her last week of basic training, with X-ray showing a femoral neck stress fracture for which she underwent surgical pinning.  The CI was unable to finish basic training.  The hip condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The hip condition, characterized as “left hip pain s/p closed reduction & pinning”, 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 w/history of left femoral neck stress fracture” as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “I feel that I should have been awarded at least 30% for my left hip and my knees”.

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 hip condition is addressed below.  The contended knee condition is not 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 20041015	VA - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5021	0%	Stress Fx, L Femoral Neck, S/P Closed Reduction Internal Fixation	5255	10%	20050122	
No Additional MEB/PEB Entries	Other x 2	20050122	
Combined:  0%	Combined:  30%*	
Derived from VA Rating Decision (VARD) dated 20050314 most proximate to date of separation [DOS]).   VARD of 20050427 included left and right knees, 5299-5261, 10% each, backdated to the day after separation.

ANALYSIS SUMMARY:  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 VASRD standards, based on ratable severity at the time of separation.

Left Hip Pain Condition.  The CI noted the onset of left hip pain in June 2006.  A bone scan in July showed findings consistent with a stress fracture across the width of the femoral neck.  She underwent immediate pinning of the stress fracture site.  The narrative summary on 20 September 2004 (2 months prior to separation) noted that the CI was still not able to run due to pain.  Physical examination reported normal hip strength, no pain with raising the leg, no hip tenderness and no pain with heel tap.  Gait was not mentioned, and the exam was otherwise silent regarding painful use or painful motion.  X-rays showed normal hardware positioning.

Two different VA examiners on 4 January 2005 (2 months after separation) observed a normal gait.  At the VA Compensation and Pension exam on 22 January 2005, the CI reported pain in her hip during cold weather, or with excessive walking or repetitive use.  She did not require any assistive devices, such as a cane or crutches.  Her condition did not affect her job (administrative) or activities of daily living.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Hip (Thigh) ROM
(Degrees)	MEB ~2 Mos. Pre-Sep	VA C&P ~ 2 Mos. Post-Sep	
Flexion (125 Normal)	120	120	
Extension (20)	20	10	
External Rotation (45)	40	55	
Abduction (0-45)	45	Not reported	
Adduction (45)	40		
Comment		No painful motion	
§4.71a Rating	0% or 10%* (PEB 0%)	0% or 10%* (VA 10%)	
		*Conceding §4.40 (functional loss) or §4.59 (painful motion)

The Board directs attention to its rating recommendation based on the above evidence.  A compensable limitation of motion was not present on either exam (VASRD codes 5251, 5252, and 5253).  The Board debated if sufficient objective evidence was present to warrant application of §4.40 (functional loss) or §4.59 (painful motion), but noted that there were no examination findings of tenderness, abnormal gait or painful motion; and therefore concluded that a 10% rating was not justified on this basis.  Board members finally considered if a 10% rating was supported using the 5255 code (femur, impairment of).  Under this code, a 10% rating is warranted for “malunion, with slight hip disability.”  The Board concluded that there was not sufficient evidence to support this approach, and therefore a 10% rating is not justified on this basis.  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 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 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	
Left Hip Pain	5021	0%	
COMBINED	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130924, 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, AR20150001097 (PD201301885)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA