RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00446
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Motor Transport Operator) medically separated for bilateral hip pain.  The hip condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  Her profile allowed for an alternate aerobic event to satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic bilateral hip pain/snapping hip syndrome,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (adjustment disorder, chronic bilateral knee pain and alcohol dependence) for PEB adjudication.  The Informal PEB adjudicated “bilateral snapping hip syndrome” as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 her application.  Her 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 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 20070319	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Snapping Hip Syndrome	5399-5317	0%	Hip Strain, Snapping Hip Syndrome, with Trochanteric Bursitis, Right Hip	5019	10%	20070706	
			Hip Strain, Snapping Hip Syndrome, with Trochanteric Bursitis, Left Hip	5019	10%		
Other MEB/PEB Conditions x 3 (Not In Scope)	Other x 5	
RATING:  0%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20070924 (most proximate to date of separation [DOS]).  
ANALYSIS SUMMARY:  

Bilateral Snapping Hip Syndrome.  The CI presented for an orthopedic evaluation in November 2004 with a 2-year history of bilateral hip pain.   At the evaluation the CI reported “popping” over the greater trochanters (outer upper thigh area) of both hips; made worse with running.  The physical examination demonstrated mild tenderness to palpation of both greater trochanters and full hip range-of-motion (ROM).  The CI was diagnosed with bilateral greater trochanteric bursitis and bilateral snapping hip syndrome.  The CI was treated conservatively without pain resolution.  In April 2006, the CI underwent iliopsoas tendon steroid injections without pain resolution.  A magnetic resonance imaging study of the hips performed 7 March 2007 was normal.  At the narrative summary examination performed a month prior to separation, the CI reported 7/10 daily hip pain with normal activities and 0/10 in a comfortable position.  There was a snapping sensation with walking.  The pain was generally throbbing with intermittent deep, sharp exacerbations.  The physical examination demonstrated painful hip ROM bilaterally.  

At the VA Compensation and Pension (C&P) examination performed 3 months after separation, the CI reported constant pain in both hips with intermittent snapping with movement.  The physical examination demonstrated abnormal gait, panful hip motion, and fatigue with repetitive motion.  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)	ORTHO ~2 Mo. Pre-Sep
	MEB ~1 Mo. Pre-Sep
	VA C&P ~3 Mo. Post-Sep
	
	Bilateral	Left	Right	Bilateral	
Flexion (125 Normal)	Full BL ROM	124/131/130	125/13/130	WNL	
Extension (20)		32/29/29	27/29/26		
External Rotation (45)		45/45/46	49/45/44		
Abduction (0-45)		51/44/44	50/45/44		
Adduction (45)		23/35/37	32/33/36		
Comment	Painful motion	Painful motion	Painful motion	Painful motion	Painful Motion	
§4.71a Rating	10%	10%	10%	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral snapping hip syndrome under a single Service disability rating of 0%, coded 5399-5317 (analogous to muscle injury- Group XVII).  VA rated each hip separately at 10%, coded 5019 (bursitis).  IAW DoDI 6040.44 if the PEB combined adjudication is not compliant with the VASRD rating criteria, each condition subsumed under the single Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed that each hip was separately unfitting and that identical coding and ratings are applicable.  The Board deliberated whether the evidence supported a higher than 0% rating.  Treatment records demonstrated subjective and objective evidence of painful motion for a 10% rating for each hip IAW VASRD 4.59 (Painful motion).  There was no evidence of a compensable limitation of hip motion or other hip pathology for a higher rating.  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 each hip.  The Board noted that VASRD code 5019 more closely approximated the CI functional impairments and recommend rating under that code.
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 snapping hip syndrome, the Board unanimously determined that each hip was separately unfitting and recommends a disability rating of 10% for each hip, coded 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Snapping Hip Syndrome 	5019	10%	
Left Snapping Hip Syndrome 	5019	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140117, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160002156 (PD201400446)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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