RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	 CASE:  Pd-2014-00170	
BRANCH OF SERVICE:  Army	 BOARD DATE:  20150814
SEPARATION DATE:  20080410		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-4 (Chaplain’s Assistant) medically separated for bilateral hip pain.  The hip condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS), but the CI could perform an alternate PT test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The hip condition, characterized as “bilateral hip pain secondary to degenerative joint disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded 3 other conditions (irritable bowel symptoms, prostate infection, and intermittent bilateral foot pain) for PEB adjudication.  The initial IPEB adjudicated the “bilateral hip osteoarthritis” as unfitting, rated 10%.  The reconsideration IPEB adjudicated “bilateral hip osteoarthritis” as unfitting, rated 20% with likely application of Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  While the CI did not initially appeal the IPEB decision for a 10% rating for bilateral hip osteoarthritis, it is noted in the documentation he did sign a “non-concur” letter.  The reconsideration IPEB state in their narrative the decision to change their rating was based on the 2008 National Defense Authorization Act.  The rating was changed from a bundled 10% rating to an unbundled rating for each hip at 10%, application of the bilateral factor for a combined rating of 20%.  The CI accepted the reconsideration IPEB findings.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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:  
   
Service Recon PEB – Dated 20080214	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Osteoarthritis	5003	20%	Degenerative Joint Disease Bilateral Hips	5003	NSC	STR	
Intermittent Bilateral Foot Pain	Not Unfitting	Degenerative Joint Disease Bilateral Feet	5003	NSC	STR	
Other x 2  (Not in Scope)	Other x 0 		
Combined:  20%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20081017 (most proximate to date of separation [DOS]).   The CI appealed in 2011 and was granted 10% for each hip on VARD 20110512.

ANALYSIS SUMMARY:  

Bilateral Hip Osteoarthritis:  The CI initially presented with left hip pain after a 2 mile run in March 2005.  A bone scan performed 24 March 2005 demonstrated osteocondritis dissecans (OCD) of the left femur.  A treated with activity modification and physical therapy with resolution of the left hip pain.  The CI presented on 11 May 2005 with reports of recurrence of left hip pain and increasing right hip pain.  At that time he had physical findings of a mildly antalgic gait; full, active, painful range-of-motion (ROM), and tenderness to palpation bilateral iliopsoas (hip) muscles.  A bone scan performed 1 June 2005 demonstrated minor pathology at the insertion of the tendons (enthesopathy) at both lesser trochanters.  The CI was placed on crutch ambulation until cleared by physical therapy.  At a physical therapy evaluation dated 8 June 2005 the CI reported mild improvement in his bilateral hip pain.  The physical examination demonstrated FAROM, pain with flexion of the hips, and tenderness to palpation bilateral iliopsoas (hip) muscles.  The CI was cleared for APFT with a recommendation to discontinue running his APFT.  The records were silent for hip pain until 5 December 2006 when a functional capacity certification noted hip pain as contributing to the CI’s physical limitations.  A magnetic resonance imaging study dated 10 January 2007 documented findings consistent with early hip joint degeneration.  At the time of the NARSUM examination, the CI reported no improvement of the bilateral hip pain.  The physical examination revealed a normal gait, painful hip motion bilaterally, and no evidence of muscle atrophy.  There was no VA Compensation and Pension examination on record.  The goniometric 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 ~ 5 Mo. Pre-Sep
(20071115) 	
Flexion (125 Normal)	90	
Extension (20)	30	
Comment	Painful Motion	
§4.71a Rating	10%	
Right Hip (Thigh) ROM
(Degrees)	MEB ~ 5 Mo. Pre-Sep
(20071115) 	
Flexion (125 Normal)	130	
Extension (20)	20	
Comment	Painful motion	
§4.71a Rating	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral hip pain condition and rated each hip at 10%, for a combined rating of 20%; coded (degenerative arthritis).  The VA initially did not service connect the bilateral hip pain condition; however, the CI appealed which resulted in a 10% rating for each hip, for a combined rating of 20%.  The Board considered whether the evidence supported a higher than 10% rating for either hip.  There was no evidence of limitation of thigh flexion to 30 degrees or hip ankylosis for a higher rating.   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 pain condition.  
Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that intermittent bilateral foot pain was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The CI initially presented with left foot pain after a 2-mile run in March 2005.  A bone scan performed on 24 March 2005 demonstrated left first and third metatarsal minor stress fractures.  Activity modification and physical therapy resulted in “significant improvement of” the left foot pain.  The CI presented on 11 May 2005 with reports of recurrence of the left foot pain and new onset right foot pain with swelling.  A repeat bone scan performed 1 June 2005 demonstrated healed stress fracture of the  left third and first metatarsal and new stress changes at the left 5th and right 3rd metatarsal bases.  The CI was placed on crutch ambulation until cleared by physical therapy.  At a physical therapy evaluation on 8 June 2005 the CI reported resolution of the bilateral foot pain. The physical therapist on 9 November 2007 documented a normal foot examination.  The NARSUM examination revealed a normal gait.  There was no VA Compensation and Pension examination on record.  

The mild bilateral foot pain condition was profiled, but not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that the bilateral foot pain significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the bilateral foot pain contended condition and so no additional disability ratings are recommended.

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.  In the matter of the contended bilateral foot pain condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20131217, 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 XXXXXXXXXXXXXXXXXXX, AR20160000412 (PD201400170)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA