RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01002
BRANCH OF SERVICE:  Army	BOARD DATE:  20150129
SEPARATION DATE:  20060621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (92Y/Supply Specialist) medically separated for bilateral hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “bilateral inferior pubic rami stress fractures,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic bilateral hip pain as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I became a medical hold in January of 2006 while being treated as a soldier in training.  Treatment was terrible and they treated everyone terribly as if they didn't believe that our medical conditions were really as bad as they were.  I had graduated were not given any rights.  I was told that if l didn't agree to the finding they would make my life miserable.  I was not allowed to see my family.”  The Board reviewed and considered your recent evidence dated 27 February 2015 in making its Board recommendation.

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 20060516	VA* - (10 Months Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain…	5099-5003	0%	Right Hip/Pelvic Stress Fracture…	5299-5255	10%	20070501	
			Left Hip/Pelvic Stress Fracture…	5299-5255	10%	20070501	
Other x 0 (Not In Scope)	Other x 0	
Combined:  0%	Combined:  20	
*Derived from VA Rating Decision (VARD) dated 20071212

ANALYSIS SUMMARY:  The PEB combined the right and left hip pain conditions under a single disability rating, coded analogously to 5003.  Although the VA Schedule for Rating Disabilities (VASRD) §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  The Board must follow suit (IAW DoDI 6040.44) if the PEB combined adjudication is not compliant with the latter stipulation, provided that each “unbundled” condition can be reasonably justified as separately unfitting in order to remain eligible for rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.

Bilateral Hip Pain Condition.  Review of the service treatment record revealed that the CI developed gradually worsening bilateral groin pain in approximately October 2005.  There was no history of acute injury or trauma.  X-rays showed stress fractures of the inferior pubic ramus (a bone of the pelvis) on each side.  Despite treatment with activity restriction, medications and convalescent leave, the bilateral hip pain did not improve sufficiently to allow return to full duty.  The commander’s statement on 7 March 2006 (approximately 3 months prior to separation) stated that the stress fractures physically limited the CI’s duty performance.  The use of a cane was required for prolonged standing or walking.  At an orthopedic evaluation on 12 January 2006 (5 months prior to separation) the CI complained of bilateral hip pain that was worse with standing, running, squatting or climbing stairs.  Examination showed “normal” but unmeasured hip range-of-motion (ROM) in all planes.  Painful motion was present.  The narrative summary on 29 March 2006 recorded complaints of bilateral groin and hip pain that was worse when walking, and prevented running or jumping.  Examination showed a mildly antalgic gait, and bilateral hip tenderness and painful motion.

At the VA Compensation and Pension exam performed 10 months after separation, the CI reported constant hip pain of moderate severity.  She reported the use of a cane from December 2005 to June 2006.  The pain affected activities such as squatting or exercising on a treadmill.  Examination showed no additional limitation with repetitive motion.  X-rays of the hips were normal.  The examiner’s diagnosis was “residual chronic tendinitis.”  

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.

Hips (Thigh) ROM
(Degrees)	MEB PT
~ 2.5 Mos. Pre-Sep	VA C&P
~ 10 Mos. Post-Sep	
	Left	Right	Left 	Right	
Flexion (125 Normal)	125	125	120	120	
Extension (20)	15	15	6	6	
External Rotation (45)	45	45	20	20	
Abduction (0-45)	40	45	30	30	
Adduction (45)	30	30	20	20	
Comment	--	--	+Painful motion	
§4.71a Rating	10%*	10%*	10%*	10%*	
*Conceding §4.59 (painful motion)

The Board directed attention to its recommendations, the Board first considered if each hip pain condition met the Board’s threshold for separate rating (as elaborated above).  In this case a bilateral hip condition was determined to fail retention standards, was profiled, and was implicated by the commander’s statement.  Members agreed therefore that each hip should be conceded as separately unfitting; and, that coding and rating features were logically identical.  While there was insufficient limitation of motion of either hip to justify a compensable rating under the 5251, 5252, or 5253 codes, the Board debated if examination findings depicted a sufficiently severe objective functional impairment to warrant application of §4.40 (functional loss) or §4.59 (painful motion).  Board members agreed that the evidence did support this approach and therefore a 10% rating for each hip is warranted.  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 hip pain condition and 10% for the left 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating chronic bilateral hip pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic bilateral hip pain condition, the Board unanimously recommends that it be rated for two separate unfitting conditions as follows:  chronic right hip pain condition coded 5099-5003 and rated 10%; and chronic left hip pain condition coded 5099-5003 and rated 10%; both 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:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Hip Pain	5099-5003	10%	
Chronic Left Hip Pain	5099-5003	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXXXXXXX, AR20150008700 (PD201401002)

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 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:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA