RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00266
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Chemical Operations Specialist) medically separated for osteoarthritis, left hip, and right sacroiliitis.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “osteoarthritis, left hip” and “osteoarthritis right SI (sacroiliac) joint,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (myopia) for PEB adjudication.  The Informal PEB (IPEB) adjudicated the left hip and right sacroiliitis as unfitting, rated 0% and 0% respectively, with likely application of Army Regulation (AR) 635-40.  The remaining condition was determined to be not unfitting. The CI made no appeals and was medically separated.  

CI CONTENTION:  The PEB did not consider his lumbar 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 Veterans Affairs Schedule for Rating Disabilities (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 20061214	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Left Hip	5003	0%	Osteoarthritis, Left Hip	5010	10%	20070330	
Right Sacroiliitis	5236	0%	Osteoarthritis, Right Hip	5010	10%	20070330	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 0	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070725 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Osteoarthritis Left Hip and Right Sacroiliitis.  The narrative summary (NARSUM) and service treatment record noted the CI injured his right hip while seeking cover and falling into a hole in December 2003.  He developed right hip arthritis that worsened over time and he developed left hip pain.  Imaging documented a left hip bony abnormality (exostosis with an avulsed fragment) interpreted as osteoarthritis and also documented degenerative changes of the right sacroiliac joint.  Orthopedic exam performed 5 months prior to separation documented right SI tenderness.  At the MEB exam, performed 3 months prior to separation, the CI reported bilateral hip pain.  The MEB physical exam noted an antalgic gait with pain-limited motion of both hips.  The back had full range-of-motion (ROM) without tenderness.  The NARSUM and MEB diagnoses were osteoarthritis, left hip and osteoarthritis, right SI joint.  

At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported moderate bilateral hip pain on activity with flare-ups.  He was taking anti-inflammatory medication daily.  Gait was normal and each hip had painful motion with ROM to the VA normal limits.  The diagnosis was bilateral hip bursitis.  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.  

Hip (Thigh) ROM
(Degrees)	MEB NARSUM ~3 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
	Left	Right	Left	Right	
Flexion (125 Normal)	110	100	125	125	
Extension (20)	10	10	30	30	
External Rotation (45)	28	25	60	60	
Abduction (0-45)	40	30	45	45	
Adduction (45)	20	20	25	25	
Comment	Antalgic gait; painful motion	Painful motion; normal gait	
§4.71a Rating	10%	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  

Osteoarthritis Left Hip.  The left hip had arthritis following trauma with pain-limited motion at the MEB exam.  No ROM exams were to the compensable limits for rating under the specific hip joint codes.  IAW VASRD §4.9 (painful motion for the VA exam) or under the criteria of 5010 (arthritis, due to trauma, substantiated by X-ray findings) using the criteria of 5003 (arthritis, degenerative), “a rating of 10 pct is for application for each such major joint … affected by limitation of motion.”  The ideal coding is 5010 rather than 5003.  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 condition.  

Right Sacroiliitis.  The left SI joint had degenerative changes and treatment note findings of tenderness.  Sacroiliitis symptoms may manifest as pain in the lower back (lumbar area of thoracolumbar spine; usually only on one side) or hip pain.  The CI had right hip pain-limited motion at the MEB exam and an antalgic gait.  The CI’s disability picture was best described as sacroiliitis with rating analogous to bursitis coded 5236-5019 at 10% with application of VASRD §4.9 (painful motion).  The Board considered rating under 5236 using the general spine rating formula, but there was insufficient evidence to support a 20% rating since the CI’s antalgic gait at the MEB was not attributed to the right SI joint, and gait was normal on the preponderance of exams.  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 right SI joint 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.  As discussed above, PEB reliance on AR 635-40 for rating the hip and SI joint conditions was operant in this case and the conditions were adjudicated independently of that instruction by this Board.  In the matter of the left hip condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  In the matter of the right sacroiliac condition, the Board unanimously recommends a disability rating of 10%, coded 5236-5019 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:  

CONDITION	VASRD CODE	RATING	
Osteoarthritis, Left Hip	5010	10%	
Right Sacroiliitis	5236-5019	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140106, 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 XXXXXXXXXXXXXXXXXXXXXXX, AR20160000432 (PD201400266)

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:

CF: 
(  ) DoD PDBR
(  ) DVA