RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	 	CASE:  PD-2014-01225
BRANCH OF SERVICE: Army 	 SEPARATION DATE:  20071020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Metal Worker) medically separated for chronic left hip pain, rated 0%.

CI CONTENTION:  She was given a higher rating for her condition by the VA.  Her 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 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 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:  
   
IPEB – Dated 20070815	VA* - (~27 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic L Hip Pain	5099-5003	0%	Mild Impingement Syndrome and Osteoarthritis of the L Hip	5252	10%	20100116	
Other x 0 (Not in Scope)	Other x 8	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20100309 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Left Hip Pain.  The record shows that the CI was initially seen for right hip pain early in basic training.  A bone scan in early March 2005 was normal for both the right and left hip.  She was treated with duty limitations and medications, but then re-aggravated her hip/thigh pain on a road march in April 2005.  An MRI of the pelvis on 17 May 2005 showed possible degenerative changes of the left hip, but no pathology of the right hip.  The record then falls silent for a year until she is seen in primary care on 25 April 2006, while deployed, with the complaint of left hip pain aggravated by running and sit-ups.  An X-ray of the pelvis on 1 May 2006 was negative for pathology of either hip.  She was seen in orthopedics the next day and a home exercise program (HEP) was recommended.  She was also treated in physical therapy, but her pain persisted.  An MRI showed joint space narrowing (degenerative joint disease, DJD) of the left hip.  In primary care on 12 October 2006, she had persistent pain, but full active range-of-motion (ROM).  An MRI arthrogram on 12 January 2007 showed retroversion of the hip joint cartilage (labrum) without an actual tear.  She was seen again in orthopedics on 31 January 2007 and 6 March 2007 and noted to have decreased and painful ROM with possible impingement of part of the hip lining (labrum).  Surgery was discussed, but the CI opted for an MEB instead.  At the MEB examination on 26 April 2007, 6 months prior to separation, the CI reported progressive left hip pain.  On examination, the CI had full ROM which was painful at the extremes of motion.  Tenderness was absent.  The narrative summary (NARSUM) was dated 28 June 2007, 4 months prior to separation.  The CI reported persistent left groin pain with occasional radiation down the front of the thigh.  She also noted “popping” and the sensation of instability.  The pain was constant and aggravated by activity.  On examination, she had tenderness and pain consistent with an impingement.  The ROM is charted below.  She was able to cross her legs and out-toe over 15 degrees.  She was diagnosed with left hip osteoarthritis and acetabular impingement.  At the VA Compensation and Pension (C&P) examination for the hip performed on 16 January 2010, 27 months after separation, the CI reported continued pain and the use of a cane.  The examination was well outside the 12-month window after separation assigned higher probative value and, accordingly, was not used for adjudication purposes.  The Board noted that this had no impact on the rating though.  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.

Left Hip (Thigh) ROM
(Degrees)	Ortho ~9 Mo. Pre-Sep	Ortho ~8 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	
Flexion (125 Normal)	120	90	124/124/124	
Extension (20)	---	---	0/0/0	
External Rotation (45)	45 (50)	30	45 (50/50/50)	
Abduction (0-45)	45 (60)	---	45 (52/54/56)	
Adduction (45)	---	---	Can cross legs	
Comment	ROM same as the right side; Impingement signs	Limp.  No impingement sings.  Painful motion	Flexion limited by pain	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the hip at 0%, coded 5099-5003 (analogous to degenerative arthritis).  The Board observed that the presence of painful motion supports a 10% rating IAW VASRD §4.59 (painful motion).  The VA, relying on an examination remote from separation, rated the hip at 10%, and coded it 5252 (limitation of flexion), effective 23 July 2009.  The Board considered this and other codes including 5255 (impairment of the femur), but found no route to a rating higher than 10%.  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 left hip impingement condition, coded 5299-5255.  

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 left hip condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5255 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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 Left Hip Pain	5299-5255	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140306, 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 XXXXXXXXXX, AR20160003963 (PD201401225)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA