RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01109
BRANCH OF SERVICE:  ArmY	 SEPARATION DATE:  20090515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Basic Trainee) medically separated for a bilateral hip condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic bilateral hip pain with bilateral labral hip tears was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated chronic bilateral hip pain as unfitting, rated 10% each.  The CI made no appeals, and was medically separated.

CI CONTENTION:  The applicant contends his condition has not improved, will not get better and dull pain is always present.  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 condition 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 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 Veteran’s 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 20090428	VA* - (1 Mo. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5009-5003	10%	Tenosynovitis…Right Hip	5024-5253	10%	20090617	
		10%	Tenosynovitis…Left Hip	5024-5253	10%	20090617	
Other x 0 (Not in Scope)	Other x 1	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20090902 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Bilateral Hip Pain.  The record shows that the CI had right hip pain in late September 2008, a few weeks after accession.  An X-ray of the pelvis was normal as was a bone scan, both on 4 October 2008.  A left hip MRI arthrogram on 14 January 2009 showed a tear of the labrum of the hip (cartilage lining of the hip socket).  A MRI arthrogram of the right hip on 29 January 2009 also showed a labral tear.  This was thought to result in impingement and secondary pain.  Surgery was discussed and declined.  The CI had been informed that the chance of success was about 50% and even after surgery, he was not likely to be retainable.  At the Narrative Summary (NARSUM) examination dated 4 April 2009, approximately 6 weeks before separation, the CI reported intermittent pain which was present on a daily basis.  He had been on Motrin for pain, but had stopped it at the time of the NARSUM.  Internal rotation of the hips was painful bilaterally, but his gait was normal.  The range-of-motion (ROM) was accomplished in physical therapy a week earlier and reduced as charted below.  Motor function was normal.  At the VA Compensation and Pension (C&P) examination dated 17 June 2009, approximately a month after separation, the CI reported flares of his pain about 3 times a week.  The ROM was reduced in extension and adduction, but otherwise normal.  Motion was painful and increased with repetitive motion although no further limitation in motion was present.  Motor function was normal.  His gait was also normal.  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.

Bilateral Hip (Thigh) ROM
(Degrees)	Ortho ~3 Mo. Pre-Sep	PT Exam ~2 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
	Left	Right	Left	Right	Left	Right	
Flexion (125 Normal)	95	95	125	125	125	125	
Extension (20)	--	--	10	10	35	35	
External Rotation (45)	20	20	--	--	35	35	
Abduction (0-45)	40	40	40	35	55	55	
Adduction (45)	--	--	--	--	35	35	
Comment	Normal non painful gait	Painful motion	Painful motion	
§4.71a Rating	0%	0%	10%	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated each hip at 10%, but the PEB coded the hips 5099-5003 (analogous to degenerative arthritis) and the VA used a dual code of 5024 (tenosynovitis) and 5253 (impairment of the thigh).  The limitation in motion was not compensable.  The Board considered these codes and others available for the hip and found no route to a rating higher than the 10% for each hip adjudicated by both the PEB and VA.  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 bilateral 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.  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 bilateral hip pain 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 re-characterization of the CI’s disability and separation determination.  

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

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, AR20160003606 (PD201401109)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA