RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01238
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20141218
SEPARATION DATE:  20090825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Special Electronic Devices Repairer) medically separated for left hip pain.  The left hip pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left hip condition, characterized as “chronic left hip pain secondary to greater trochanteric bursitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions (left ankle pain, intermittent right hand pain secondary to boxer’s fracture, bilateral sensorineural hearing loss and bilateral tinnitus) for PEB adjudication.  The Informal PEB adjudicated “chronic left hip pain secondary to greater trochanteric bursitis” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  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 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 IPEB – Dated 20090724	VA - (~1 Mo. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5019	10%	Left Hip Pain and Stiffness Diagnosed as Chronic Greater Trochanteric Bursitis, Left Hip	5251	10%	20090911	
Other x 4  (Not in Scope)	Other x 9	20090917	
Rating:  10%	Combined Rating:  50%	
Derived from VA Rating Decision (VARD) dated 20100205 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Left Hip Condition.  The CI’s non-trauma related left hip pain began after a physical fitness test in July 2008, localized to the lateral hip.  His pain initially occurred intermittently but then became constant in October 2008.  Bone scan of the left hip was unremarkable.  Orthopedic consultation dated 23 January 2009 recorded the CI had continued left hip pain over the greater trochanter.  Physical examination noted tenderness to palpation (TTP) over the greater trochanter region of the left hip, with increasing pain with left hip flexion and adduction.  Left hip range-of-motion (ROM) recorded flexion of 90 degrees with pain.  The physician diagnosed trochanteric bursitis and the CI was referred to physical therapy (PT).  A month later, PT recorded full ROM of the hip with pain.  The CI was treated with non-steroidal anti-inflammatory medication which was of limited benefit.  He also received injections that helped for a couple of days.  Radiographs dated 23 April 2009 demonstrated minimal inflammatory change over the greater trochanter which was confirmed by a magnetic resonance imaging, and consistent with trochanteric bursitis.  Having failed conservative treatment, the CI was referred to the MEB.  The 6 July 2009 MEB narrative summary was based upon a physical examination performed on 3 June 2009.  The physician noted the CI had two steroid injections in effort to relieve his pain.  He was not a surgical candidate.  The CI noted he could not run or do sit-ups; he was not able to pass the Army physical fitness test (APFT) and had not performed an APFT since July 2008.  He had constant daily pain that increased with walking and normal everyday activities.  His pain increased in cold rainy weather as well.  The CI took Ibuprofen as needed.  Physical examination of the left hip noted decreased ROM secondary to pain only.  Flexion was recorded at 100 degrees (125), extension at 10 degrees (10), and abduction at 20 degrees (30).  ROM did not decrease after repetitions.  There was TTP at the greater trochanter, gait and muscle strength were normal.  The CI could cross his legs bilaterally.  The VA Rating Decision dated 5 February 2010 reported the finding of painful motion.  Left hip ROM recorded flexion of 110 degrees and normal abduction.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded 5019 (bursitis), for loss of motion of a single major joint.  The VA rated the condition at 10% coded 5251 (thigh, limitation of extension).  The Board reviewed the requirements for a higher rating under the analogous code of 5003 (allowed under the 5019); however, noted there were no evidence of incapacitating episodes, therefore, a higher rating under this code was not warranted.  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 left hip 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 left hip 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20100306, 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, AR20150009561 (PD201401238)

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