RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00450
BRANCH OF SERVICE:  ARMY 	BOARD DATE:  20141114
SEPARATION DATE:  20070511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty initial entry trainee PV2/E-2 (13B/Cannon Crewmember) medically separated for chronic left hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements for the award of his Military Occupational Specialty or satisfy Army physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic left hip pain, status post percutaneous pinning of a left femoral neck stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated his condition as unfitting, rated at 10%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI attached a two page statement to his application which was reviewed by the Board and considered in its recommendations.

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 condition is addressed below.  The CI also requested that the conditions affecting his feet and hearing be included in the scope.  However, these conditions were not identified by the PEB and thus are 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 20070426	VA - (8 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain…	5099-5003	10%	Status Post Left Hip Percutaneous…	5299-5255	10%	20080104	
			Postoperative Surgical Scars, Left Hip…	7804	10%	20080104	
Other x 0  (Not in Scope)	Other x 2 		
Rating:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20080125 (most proximate to date of separation)

ANALYSIS SUMMARY:  

Left Hip Pain.  The narrative summary (NARSUM) notes that the CI developed pain in his left hip after falling into a ditch in July 2006.  Initially, routine X-ray images revealed no acute fractures, but some sclerosis (scar) in the femoral neck (upper, inner leg bone where it joins the hip joint) possibly “related to an earlier stress fracture”.  A bone scan, for clarification, was obtained on 24 July 2006, revealed a stress fracture in this area.  In August 2006, three surgical screws were placed percutaneously across the stress fracture site for stabilization.  Multiple post-operative X-ray images revealed the area healed without non-union or complications of the screws.  Post operatively, the CI developed pain with motion in the hip.  The CI was evaluated by physical therapy (PT) on 11 October 2006 and 22 February 2007.  Range-of-motion (ROM) results are presented in the chart below.  Numerous evaluations from February 2007 until January 2008 revealed the CI to have a normal gait.  

At the MEB NARSUM evaluation 27 March 2007 (2 months prior to separation), the CI reported difficulty standing and sitting for long periods of time.  He noted that the hip condition impacted his activities of daily, living such as the inability to sleep through the night without being awakened with “aches and pains”.  On physical examination, the examiner observed that the CI was able to ambulate without “any signs of a limp”.  ROM evaluation was quoted from the PT exam obtain on 22 February 2007, as noted in the chart below.  Motor strength was reported to be slightly reduced compared to the right hip for flexion, extension and adduction.  Neurovascular exams were normal.

At the VA Compensation and Pension (C&P) exam performed on 4 January 2008 (8 months post-separation), the CI reported working as a “press operator”.  He denied instability and locking of the hip and uses of crutches.  On physical exam, motor strength and sensation were normal.  ROM evaluation is presented in the chart below.  Three 1 cm scars were reported in the left hip area.  These were described as well-healed, not affixed to under lying tissue but tender to palpation.  During the VA’s C&P gastrointestinal evaluation the examiner noted that the CI’s gait was normal and that he was able to “walk across the room without evident problems”. 

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Left Hip (Thigh) ROM
(Degrees)	
PT ~7 Mo. Pre-Sep
(200601011)	MEB ~ 2.5 Mo. Pre-Sep
(20070222) 	VA C&P ~ 8 Mo. Post-Sep
(20080104)	
Flexion (125 Normal)	110 with pain	120	110	
Extension (20)		15	20	
External Rotation (45)		30	60	
Abduction (0-45)		50	45	
Adduction (45)		25	15	
Comment	Mild antalgic gait. Hip pain improving.	Can sit cross-legged. Can turn feet outward >15 degrees.  Can not squat more than 50% secondary to pain. Slight limp on left. Hip strength 4+/5	Motor, sensation, gait normal.	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the hip condition as 10% using different codes.  The PEB used code 5099-5003 (analogous to arthritis/slight) invoking the Army’s pain policy and the VA used code 5299-5255 (analogous to femur disability/slight).  The VA also included a 10% rating, coded 7804 (scars), for painful surgical scars.  The Board unanimously agreed that the hip condition rose to the level of 10% for painful motion IAW §4.40 and §4.59.  The Board unanimously agreed that the record did not support a compensable rating under ROM criteria.

The Board agreed that the hip condition was “mild” and rose to rating no higher than 10% under code 5255, which requires “moderate” disability for a 20% rating.  The Board noted the slightly decreased motor strength found on the NARSUM exam and considered a rating for muscle injury, code 5313, (Group XIII, Hip) IAW §4.73.  The Board agreed that no higher rating than 0%, slight, was supported under this code.  The Board considered a rating under code 7804 (scars) but was unable to do so as the surgical scars were small and well healed without inflammation, irritation or adherence to underlying tissue.  The Board found no other appropriate codes for rating consideration and no pathway to a higher than a 10% rating for the hip condition.  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 hip 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 the USAPDA pain policy for rating the hip condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the hip 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140110, 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, AR20150003759 (PD201400450)

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