RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01236
BRANCH OF SERVICE:  Army	BOARD DATE:  20150106
SEPARATION DATE:  20090811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (Basic Trainee) medically separated for right hip and pelvic pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS); however, her profile indicated she could take an alternate physical fitness test.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The hip and pelvic condition, characterized as “chronic right hip and pelvic pain with healing stress fracture of the right femoral neck and right inferior pubic rami” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “right hip and pelvic pain with healing stress fracture of the right femoral neck and right inferior pubic rami” 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:  “Rating only 10%, since injury.  Still having pains and issues to living and working a healthy lifestyle.  Very limited to everyday activities.  I feel my rating was unfit.  After almost 5 years from being medically discharge, I still have the same pain and problems.  Im [sic] limited to activities and working.  I can no longer partake in any incline and weight lifting.  My work days are shorter which cause less income and Im [sic] constantly taking IBProfin [sic] for pain.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting hip condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20090724	VA - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip and Pelvic Pain	5299-5255	10%	Right Hip Capsulitis	5010-5252	10%	20091102	
Other x 0 (Not in Scope)	Other x 0 		
Rating:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20100111 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Hip.  The CI’s right hip pain began during the third week of training and a bone scan of the led to the diagnosis of right sacral stress fracture in November 2008.  She was placed on 30-day convalescent leave and her pain improved.  The CI re-started basic training and shortly afterwards, she developed right foot pain diagnosed as midfoot and cuneiform stress fractures.  A temporary profile was placed and she was allowed to continue her training but developed right hip and right pelvic pain.  Magnetic resonance imaging of the right hip and pelvis in April 2009 revealed a right femoral neck stress fracture and a right inferior pubic rami stress fracture.  Right hip radiographs in April 2009 recorded the absence of fracture, dislocation or any other bony pathology.  She was again placed on convalescent leave and was unable to return to training.  On 10 June 2009, the CI underwent a separation physical examination that recorded constant hip pain as the only clinical finding.  Hips showed full range-of-motion (ROM) with the exception of some limitation in adduction during hip flexion with pain on motion.  Gait was normal, and there was no evidence of neurosensory deficits.  The CI ambulated without the use of assistive devices.  The MEB narrative summary dated 25 June 2009, noted the CI took Motrin and an occasional narcotic based medication.  The CI reported pain intensity of 3/10 that increased with weight bearing activities and reached 4/10.  Physical examination of the right hip recorded tenderness to palpation along the right femoral neck, inferior pubic rami and the right hip abductor muscles.  There was no popping or snapping noted during ROM.  ROM was recorded on 11 June 2009 by physical therapy using a goniometer.  Right hip flexion was measured at 120 degrees without pain, extension of 15 with pain at 10 degrees, abduction of 40 degrees with pain at 30 degrees.  Gait and muscle strength of the lower extremities were normal.  The examiner noted radiographs of the pelvis on 2 June 2009 demonstrated elements consistent with a healing stress fracture of the right femoral neck.  The diagnosis of chronic right hip and pelvic pain with healing stress fracture of the right femoral neck and right inferior pubic rami was recorded.  The examiner opined since the CI had developed repeated stress fractures, she was likely prone to have them and therefore, would not likely be able to complete the physical activities required of her to complete her basic and MOS training.

The VA Compensation and Pension examination dated 2 November 2009, 3 months after separation, recorded that the CI reported she injured her tail bone on a fall during training exercises and had experienced pain in the right hip that radiated down the anterior thigh to just above the knee.  Her pain was aggravated by walking more than one mile and with weight bearing activities.  She ambulated without assistive device, and had worked part-time as a bartender since separation.  Physical examination of the right hip was significant for pain only.  Her gait was normal and ROM right hip flexion to 115 degrees, extension to 30 degrees and abduction to 15 degrees with evidence of painful motion.  There was no evidence of limitation of motion due to repetition.  Straight leg test was negative, and there was no evidence of neurovascular or neuromuscular compromise.  There was no evidence of joint instability, or deformities.  Radiographs on 2 November 2009 demonstrated normal bone mineralization, no evidence of a degenerative process, normal contour of the femoral heads, and normal sacroiliac joint and normal pelvis.  The condition was diagnosed as right hip capsulitis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded analogously 5299- 5255(impairment of femur), for slight hip disability.  The VA rated the condition at 10% coded analogously 5010-5252 (thigh, limitation of flexion), based on painful motion.  The Board reviewed the requirements for a higher rating under the 5255 code; however, there was no evidence to support that the hip condition approached the moderate level of disability since the only clinical finding was painful motion, and tenderness to palpation.  The Board next reviewed the limitation of motion codes 5251, 5252 and 5253; however, the evidence did not support a compensable rating under any of these codes.  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 chronic right hip and pelvic pain 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 chronic right hip and pelvic 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 20140307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150007663 (PD201401236)

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