RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00720	
BRANCH OF SERVICE:  NAVY	 SEPARATION DATE:  20070615		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve EO1 (Equipment Operator) medically separated for a right hip condition.  The right hip condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty [LIMDU] and referred for a Medical Evaluation Board (MEB).  “Chronic right hip pain” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded “right hip labral tear and chondromalacia s/p arthroscopy” for PEB adjudication. The Informal PEB adjudicated “chronic right hip pain” as unfitting, rated 10%.  The remaining condition was determined to be a Category II condition (contributing to the unfitting right hip condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI 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 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:  
   
Service IPEB – Dated 20070426	VA – (~6 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Rt Hip Pain	5299-5003	10%	Right Hip Labral Tear & Chondromalacia S/P Hip Arthroscopy	5252	NSC*	20070102
20070207	
Other MEB/PEB Conditions x 1  (Not in Scope)	Other x 2 	
Rating:  10%	Rating:  NSC	
Derived from VA Rating Decision (VARD) dated 20070912 (most proximate to date of separation [DOS]).   
*VARD dated 20091026 rates the right hip condition 10% effective 20051108.

ANALYSIS SUMMARY: 

Right Hip Condition.  The CI sustained a right hip injury in September 2005.  Radiographic evaluations were normal and he was treated conservatively.  At an orthopedic evaluation dated 16 February 2006 the CI reported severe right hip pain which radiated into the right testicle and complained of a right sacroiliac region trigger point.  The pain was worse with all activity.  On physical examination there was tenderness to palpation over the site of his pain which worsened with internal rotation of the hip and was relieved by external rotation.  A magnetic resonance imaging study performed 27 September 2006 revealed an anterior-superior labral tear (tissue lining the hip joint).  On 1 November 2006 the CI underwent arthroscopic right hip debridement and chondroplasty (joint resurfacing).  At the narrative summary (NARSUM) examination performed 27 March 2007, the CI reported constant, 4/5 aching right hip pain which increased to 8/10 with activity.  On physical examination there was a slight limp and pain with right hip internal and external rotation.  A diagnosis of chronic right hip pain was rendered.  At an orthopedic evaluation dated 29 June 2007, 8 months after the surgery, the CI continued to report groin pain and some limitation of activities.  On physical examination his gait was normal and there was discomfort with maximal flexion with internal rotation.  At the VA Compensation and Pension (C&P) examinations performed on 2 January 2007 and 7 February 2007, the CI reported daily right hip pain, physical therapy twice per week, and the use of Tramadol (opioid pain medication).  On physical examination there was a normal gait and pain limited motion.  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.

Right Hip (Thigh) ROM
(Degrees)	MEB ~ 12 Mo. Pre-Sep	VA C&P (PT) ~ 6 Mo. Pre-Sep	
Flexion (125 Normal)	90	103	
Extension (20)	10	Lacks 12 deg from neutral	
External Rotation (45)	60	32	
Abduction (0-45)		29	
Adduction (45)		12	
Comment	No pain on motion; walks w/ slight limp		
§4.71a Rating	10% 	10% 	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA initially non-service connected the right hip, but subsequently rated the right hip 10%, coded 5252 (thigh limitation of flexion).  The Board considered whether the evidence supported a higher than 10% rating.  There was no evidence of thigh limitation of flexion to 30 degrees, loss of abduction beyond 10 degrees, or hip ankylosis for a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right hip was appropriately recommended in this case.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the right hip labral tear and chondromalacia status post hip arthroscopy was a related Category II diagnosis.  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.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change to the Category II designation and so no additional disability rating is 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 chronic right hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right hip labral tear and chondromalacia status post hip arthroscopy conditions, the Board unanimously recommends no change from the PEB determination as Category II.  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 20140205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Jan 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USMC  
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC 
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)