RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01080
BRANCH OF SERVICE:  Army	BOARD DATE:  20141212
SEPARATION DATE:  20080626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Army National Guard E-1 (Basic Trainee) medically separated for a right hip condition.  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 right hip condition, characterized as “chronic right hip pain due to residual of healing 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 “healing low grade right femoral neck stress fracture, resulting in right hip pain” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Chronic pain in right hip, numbness going down right leg, falls due to right hip/leg giving out.”

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 Admin. Corr. IPEB – dated 20080609	VA – (3 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5299-5255	10%	Right Hip Condition	5255-5252	10%	20080911	
Other x 0 (In Scope)	Other x 0		
Combined:  10%	Combined:  10%	
          Derived from VA Rating Decision (VARD) dated 20081124 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right hip pain.  In January 2008, this CI injured her right hip while running.  She was found to have two fractures of the right femoral neck.  She was treated with physical training and rehabilitation.  However, her hip pain persisted and MEB was initiated.  The MEB physical examination (PE) was in May 2008.  At that time she was using crutches, but without crutches her gait was normal.  There was tenderness over the right greater trochanter and trochanteric bursa, but no other bony or soft tissue tenderness.  No ligamentous laxity was noted.  Neurological examination revealed normal muscle strength in the hip extensors and flexors bilaterally.  She was able to cross both legs.  The CI had pain with extreme flexion and abduction.  Range-of-motion (ROM) of the right hip was measured with goniometer, and is summarized in the chart below.

Eleven weeks after separation, in September 2008, she had a VA Compensation and Pension exam.  She reported that she had little pain at baseline, and the right hip did not seem unstable.  However, increased activity would cause a flare-up of right hip pain.  On PE, she was alert and in no acute distress.  Her gait was antalgic.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Hip ROM
(Degrees)	MEB ~ 7½ weeks Pre-Sep
(20080505)	VA C&P ~ 11 weeks Post-Sep
(20080911)	
Flexion (125 Normal)	112	90	
Extension (20)	22	30	
Abduction (0-45)	22	30	
Comment	Pain with motion	Pain with motion	
§4.71a Rating	10%*	10%*	
	*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully examined all available evidence, and directed attention to its rating recommendation.  The Army PEB and the VA chose different coding options for the right hip condition, but both assigned a 10% disability rating.  The Board considered the results of the two ROM examinations shown above.  At both exams, the CI had 90 (or greater) degrees of right hip flexion, and 22 (or greater) degrees of right hip abduction.  The May 2008 MEB exam was closer to the date of separation and therefore had significant probative value.  At that exam, the CI’s gait was normal.  After a thorough review of the treatment record, the Board determined that the right hip condition was essentially non-compensable based solely on the VASRD §4.71a codes for the hip and thigh (5250 through 5255).  However; IAW VASRD §4.40, §4.45, and §4.59, a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled.  A rating of 10% is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.

After reviewing the evidence, all Board members agreed that a rating of 10% was appropriate for the right hip condition.  The Board tried to find a path to a higher rating, using other codes which could be applied to the hip condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling hip condition which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends no change to the PEB adjudication of the unfitting right hip condition.  It is appropriately coded 5299-5255 and IAW VASRD §4.40, §4.45, and §4.59, meets criteria for a 10% rating due to painful motion of a major joint.

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 right hip condition and IAW VASRD §4.40, §4.45, and §4.59, 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 20140228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

SAMR-RB									

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150009584 (PD201401080)

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