RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01138
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Transportation Management Coordinator, medically separated for “bilateral hip pain,” with a rating of 10% for each hip, and a combined disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in her application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20081230	VARD - 20090822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5299-5255	20%	Bursitis, Bilateral Hips	5019	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in November 2006 without specific injury noted.  Diagnostic imaging (X-rays and MRI) were normal.  The CI was returned early from deployment due to bilateral hip pain, and orthopedic assessment was bilateral hip bursitis.  Additional diagnostic imaging (X-rays and bone scan) was negative.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral soft tissue hip pain, unresponsive to all modalities of therapy” for PEB adjudication.  
At the MEB examination (recorded on DD Forms 2807 and 2808) and NARSUM both dated 26 September 2008, 5 months prior to separation, the CI reported constant bilateral hip pain with difficulty kneeling, jumping, standing, or moving of any kind.  Physical examination showed hip range of motion (ROM) was preserved with pain with all hip movement and tenderness laterally on both hips.  Straight leg raise (for back radicular symptoms) did not cause radiating pain at 90 degrees on either side.  Bilateral lower extremity strength and reflexes were normal.  The physician attached goniometric bilateral hip ROMs performed by physical therapy (PT) on 7 October 2008 (4 months prior to separation).  The PT ROMs were extremely limited (as specified in the PEB disability description), and indicated that the CI was able to sit with legs crossed without pain and to toe out 15 degrees with increased pain.  The examiner stated “clinically, hip range of motion was preserved … (PT ROMs).  I cannot determine the cause of the marked limitation of ROM, and any cause for this limitation would be speculation on my part.”  The NARSUM text indicated the CI walked with a limp.  

A VA clinic intake note dated 16 July 2009, performed 5 months after separation, the CI reported continued bilateral hip pain.  Physical examination showed a normal gait with bilaterally tender hips and pain with abduction and adduction of both hips.  Gait was normal and there was no leg weakness or neurologic deficit.  

The VARD indicates that the CI did not report for a scheduled VA Compensation and Pension (C&P) evaluation, and no VA C&P examination proximate to separation is in evidence.  The VA C&P examination dated 22 May 2010 performed 15 months after separation, showed bilateral painful hip motion limited to 90 degrees of flexion, with other axis of motion normal.  Posture and gait were normal and there was no weakness of either leg.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain condition 10% for each hip, coded 5299-5255 (Femur, impairment of), citing a comprehensive rationale of normal diagnostic imaging, non-concordant ROM measurements, and functional loss analogous to slight femur impairment of each hip joint.  The VA rated the bilateral hip condition 0% coded 5019 (bursitis), based on the STR and no available VA C&P examination.  

There was deliberation on the single goniometric PT ROM measurements that did not align with either the underlying pathology or the remainder of the record of evidence.  The Board agreed that the MEB NARSUM examination had the highest probative value for rating at separation.  Board members considered that the objective findings and associated disability for each hip were identical, and agreed with the PEB that the respective ratings should therefore be the same.  The Board concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each hip IAW §4.59 and §4.40.  There was insufficient evidence for moderate hip disability of either hip to warrant any higher rating.  

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 pain condition.  

BOARD FINDINGS:  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.  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 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

14 NOV 2016

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, AR20160016223 (PD201401138)
	
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