RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01137	
BRANCH OF SERVICE:  Army	 BOARD DATE:  20150811
SEPARATION DATE:  20080306		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (PATRIOT Fire Control Enhanced Operator and Maintainer) medically separated for chronic right hip impingement.  The right hip condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right hip condition, characterized as “right hip femoral acetabular impingement” 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 right hip femoral acetabular impingement” as unfitting, rated 10%, with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.  

CI CONTENTION:  The CI elaborated no specific contention in his 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 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 (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 Correction IPEB – Dated 20080130	VA* - (1.9 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Impingement	5099-5003	10%	S/P Right Hip Impingement	5252-5253	10%	20080502	
Other x 0  (Not in Scope)		
Combined:  10%	Combined:  20%	
* Derived from VA Rating Decision (VARD) dated 20080724 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Hip Impingement.  The Service treatment record (STR) documented a report of leg and groin pain that began in April and May 2006 (11 months after Service entry).  There was no mention of trauma.  Orthopedics was consulted after having minimal improvement with physical therapy.  The CI underwent right hip surgery for acetabular impingement in June 2007 (9 months pre-separation).  Despite post-operative physical therapy, he made minimal progression and continued to experience painful and decreased range-of-motion (ROM).  The MEB DD Form 2808, Report of Medical Examination, was performed on 20 December 2007 (2 months pre-separation) and documented “decreased” and “limited” ROM of the right hip.  

The MEB NARSUM was performed on 27 December 2007 (2 months pre-separation).  The CI reported having worsening right hip pain with “walking over a mile, walking up and down stairs at grades, sitting for greater than thirty minutes at a time, and lifting heavier than twenty pounds.”  The examiner documented a normal gait, forward flexion of 90 degrees (normal 125), extension of 0 degrees (normal 20), adduction of 15 degrees (normal 45), and abduction of 45 degrees (normal).  Radiographs in December 2007 documented evidence of prior surgeries, with a “well preserved joint space” and “absence of arthritis” or other bony lesions.  Formal physical therapy active ROMs were performed on 14 January 2008 (2 months pre-separation) and documented flexion of 100 degrees, extension of 10 degrees, abduction of 35 degrees, normal external rotation (“toe out”), and inability to adduct (cross legs) due to “stiffness.”  

At the VA Compensation and Pension (C&P) exam performed on 2 May 2008 (2 months post-separation), the CI elaborated similar functional limitations as above.  He further reported working fulltime despite termination from a prior job “because he couldn’t kneel to install security sensors on doors.”  He reported “right hip pain of 2-3/10 with daily activities” that was “stable;” stiffness, weakness, and giving way; and denied instability, locking, effusions, and flare ups.  The examiner documented an unassisted normal gait, 5/5 strength without atrophy or spasm; and tenderness over the lateral aspect without effusion.  There was painful motion; forward flexion to 95 degrees, extension to 25 degrees, external rotation (“toe out”) greater than 15 degrees, inability to cross legs (adduction); and inability to test for additional limitations due to painful motion after repetition.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the “chronic right hip femoral-acetabular impingement” as unfitting and rated 10% coded analogously as 5099-5003 (degenerative arthritis) for mechanical loss of motion; this was consistent with VASRD §4.71a criteria for that code, based on the evidence.  The VA granted a 10% rating for “S/P right hip femoral-acetabular impingement” coded analogously as 5252-5253 (thigh, limitation of flexion and thigh, impairment of …).  Application of VASRD §4.59 (painful motion), was supported by STR documentation (painful motion and mechanical limitations) to support a 10% rating coded as 5003 or 5253.  There was no STR evidence of ankylosis (5250), abduction limited to 10 degrees (5253), or flexion limited to 30 degrees (5252) to support a higher rating.  None of the other hip/thigh joint codes (5254, 5255) were applicable to this case.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right 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 right hip condition, 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 recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
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, AR20150015523 (PD201401137)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA