RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00771
BRANCH OF SERVICE:  Army	BOARD DATE:  20140717
SEPARATION DATE:  20070521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (25Q10/Communications Specialist) medically separated for a chronic right hip pain and snapping hip condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty but could perform an alternate physical fitness test.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right hip condition, characterized as “snapping hip syndrome,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  One other condition, sleepwalking, was submitted by the MEB.  The Informal PEB adjudicated “chronic right hip pain and snapping hip from an iliotibial band syndrome” as unfitting, rated 0%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The sleepwalking condition was determined to be not unfitting and therefore not ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

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 right hip condition is addressed below; no additional conditions are 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 20070405	VA - (*1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Rip Hip Pain	5399-5314	0%	Right Snapping Hip	5099-5019	10%	20070628*	
No Other MEB/PEB Entries in scope	Other x 10		
Combined:  0%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20070904 (most proximate to date of separation [DOS]).   *C&P Exams Missing.

ANALYSIS SUMMARY:

Chronic Right Hip Pain Condition.  The CI’s right hip pain began near the completion of basic training after a long march.  Persistent pain was eventually determined to be due to snapping hip syndrome, a condition resulting from movement of the iliotibial band across the lateral aspect of the hip.  Physical therapy and medications were not helpful.  Radiological studies were normal.

The commander’s statement dated 27 February 2007 (3 months prior to separation), reported that the CI demonstrated painful limping.  The narrative summary examiner on 1 March 2007 reported that pain was worsened by running, speed walking, sit-ups and flutter kicks.  She was unable to sleep on her right hip, dance or snowboard due to the condition.  Examination showed snapping of the iliotibial band over the greater trochanter during flexion and extension of the hip.  An orthopedic exam performed on 5 March 2007, noted tenderness of the greater trochanter and full range-of-motion (ROM) of the hip.

The VA Compensation and Pension (C&P) exam performed a month after separation was not in evidence.  VA C&P dated on 4 September 2007, included a report of intermittent right hip pain brought on by weight-bearing activity.  Impact on daily, recreational, occupational or leisure activities was not described.  The above cited exam findings were of “smooth and coordinated gait” and tenderness of the right trochanter.  Hip ROM was reportedly 125 degrees of flexion (normal 125 degrees), 30 degrees of abduction (normal 45 degrees), 25 degrees of adduction (normal 45 degrees) and 50 degrees of external rotation (normal 45 degrees).  Extension was not reported and it was not specified if measurements were goniometric.  Painful motion was present during internal and external rotation.  The CI was also observed to “squat to the floor and recover,” although evidence of painful movement during this maneuver was not described.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous code 5314 (muscle Group XIV), concluding that the severity was best characterized as “slight.”  The VA assigned a 10% rating for “painful or limited motion” under an analogous code 5019 (bursitis).  The Board considered the PEB’s muscle coding approach and agreed that “slight” was the most accurate descriptor of the condition; thus a 0% rating was warranted.  Rating under the 5019 code is based on limitation of motion of the affected joint.  In this case, the evidence did not show that compensable limitation of motion was present (VASRD codes 5251, 5252, and 5253).  Finally, Board members debated the application of VASRD §4.40 (functional loss) or §4.59 (painful motion), but concluded that application of VASRD §4.73 (muscle injury) best fit the clinical description and did not warrant a change from the PEB coding.  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 chronic right hip pain 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.  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 pain condition and IAW VASRD §4.73, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140130, 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 XXXXXXXXXXXXXXXXXX AR20150006639 (PD201400771)

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