RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01502
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a traditional drilling National Guard E-3 (Food Service Specialist) medically separated for right hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right hip pain”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 The “bilateral foot pain”, “bilateral plantar fasciitis” and “bilateral knee pain” conditions were identified by the MEB and also forwarded as failing retention standards.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right hip pain” as unfitting, rated 10% citing application of the Veterans Affairs 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 applicant contended that her left hip, feet and knees should be unfitting and rated.  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 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 20090901	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	10%	Residuals, Right Hip Stress Fracture	5252	10%	STR	
Bilateral Foot Pain	Not Unfitting	Bilateral Plantar Fasciitis	5099-5020	Not Service Connected	
Bilateral Plantar Fasciitis	Not Unfitting				
Right Knee Pain	Not Unfitting	Bilateral Knee Condition	5257	Not Service Connected	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20100723 (most proximate to date of separation (DOS)).  
ANALYSIS SUMMARY:  

Right Hip Condition.  The service treatment record (STR) and MEB Narrative Summary (NARSUM) documented a right hip strain that occurred in July 2007 during basic training preventing her from completing advanced individual training.  At a physical therapy visit in July 2007 (28 months pre-separation), the CI reported insidious onset of bilateral hip pain, rated 4-5/10, and increased pain with walking, running, and weight bearing activities.  The examiner documented 4/5 strength of the bilateral hip flexors; a normal neurologic exam; and full range-of-motion (ROM) with pain during flexion and Faber testing (hip abduction/rotation).  At a clinic visit in August 2007 (27 months pre-separation), the examiner documented a normal gait, tenderness on palpation of the bilateral hips, and pain elicited by hip motion.  Initial radiographic imaging in July, August and September 2007 showed no fracture, dislocation, or joint effusion of the hip or pelvis.  

There were six documented visits for osteopathic manipulation therapy in 2008 (March, April, May, June and October; 13-20 months pre-separation) during which the CI reported left or right hip pain.  Examinations documented only nonspecific restrictions of internal rotation.  At a physical therapy visit in April 2009 (7 months pre-separation) for ROM measurements, the examiner documented right hip flexion of 123 degrees (normal 125) with pain, normal extension, and abduction of 35 degrees (normal 45).  Although specific measurements were not documented, the examiner stated that there was sufficient hip adduction to cross the legs and sufficient external rotation ‘out toeing’ of more than 15 degrees bilaterally.  There was no change in ROM after repetition.  Radiographs in April 2009, obtained for chronic bilateral hip pain, documented a normal exam with absence of fracture, subluxation or significant degenerative change.  Further imaging in May 2009 documented no evidence of labral (cartilage) tear or separation, no bony abnormalities, no evidence of stress fracture or bone marrow changes, and no other evidence of traumatic injury to the right hip.  During osteopathic visits in April and May 2009, the CI reported chronic bilateral low back and hip pain.  The examiner documented a normal gait with no difficulty transitioning from a sitting position to standing or turning; and "sluggish" internal rotation bilaterally.  On the MEB DD Form 2697 Report of Medical Assessment dated 8 April 2009, the CI reported difficulty with lifting heavy objects, and standing or sitting for long periods of time.  

The MEB NARSUM exam was performed on 21 July 2009 (4 months pre-separation).  The CI reported 6/10 right hip pain worsened by running or walking.  The examiner documented normal hip ROM with pain on forward flexion and external rotation.  On the MEB DD Form 2808 Report of Medical Examination dated 8 September 2009 (2 months pre-separation), the examiner diagnosed a “right hip strain” and documented her ability to squat during the exam.  The CI failed to report for the VA Compensation and Pension (C&P) exam scheduled for 6 July 2010.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the right hip pain as unfitting, and rated 10% for evidence of painful motion, coded as 5099-5003 (degenerative arthritis).  A VA rating decision (dated 23 July 2010) indicated that the 10% VA rating was based on service treatment records, and was coded as 5252 (thigh, limitation of flexion).  There was no evidence of ankylosis, extension limited to 5 degrees, or flexion limited to 30 degrees.  There was no evidence of limitations in abduction beyond 10 degrees, adduction (inability to cross legs), or rotation (inability to ‘toe out’ to more than 15 degrees) in support of a higher than 10% rating.  The STR documented painful motion and near normal ROMs with normal radiographic evaluations in support of a 10% 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 right hip condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral foot, right knee, and left hip conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

Bilateral Foot Condition.  The bilateral foot condition (bilateral plantar fasciitis and bilateral foot pain) was not implicated in the commander’s statement.  The condition was not profiled with the permanent hip profile in February 2008, but was added to the final profile dated 24 June 2009 (5 months pre-separation).  It was judged to fail retention standards by the MEB, but not by the PEB.  There was no performance based evidence from the record that the bilateral foot condition significantly interfered with satisfactory duty performance.  

Right Knee Condition.  The right knee condition and was not implicated in the commander’s statement.  Bilateral femoral stress fractures (bilateral knees) were temporarily profiled, and expired in April 2008 (19 months pre-separation).  It was added to the final profile dated 24 June 2009 (5 months pre-separation).  The right knee condition was judged to fail retention standards by the MEB, but not by the PEB.  There was no performance based evidence from the record that the right knee condition significantly interfered with satisfactory duty performance.  

Left Hip Condition.  The left hip condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards by the MEB or the PEB.  There was no performance based evidence from the record that the left hip condition significantly interfered with satisfactory duty performance.  

All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

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 strain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral foot, right knee and left hip conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140219, 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 XXXXXXXXXXXXXXXXXX, AR20160003125 (PD201401502)

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