RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01638
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20080415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Ammunition Technician, medically separated for “impingement syndrome, left hip,” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  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 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 PEB - 20080204	VARD - 20080627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Impingement Syndrome, Left Hip	5299-5003	10%	Recurrent Dislocations of Left Hip	5252	30%	20080602	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Hip Condition.  The service treatment record (STR) was inconsistent on the original mechanism of injury with resultant chronic left hip pain.  Originally thought to be a labrum tear, it was later discovered, via an arthroscopy performed on 28 August 2006, to be “snapping” of the iliopsoas muscle.  He had multiple hip injections that brought intermittent relief.  Due to the return of increased pain, he underwent a surgical release of the left iliopsoas tendon on 19 January 2007.  Post-operatively, his painful snapping of the left hip did not resolve.  He started on his third LIMDU as of 9 October 2007 and was referred to a Medical Evaluation Board (MEB). 
At the MEB narrative summary (NARSUM) examination performed on 28 December 2007 (4 months prior to separation), the CI endorsed a 6-7/10 left hip pain that limited his ability to walk.  He had pain with any walking, sitting or prolonged standing.  He additionally endorsed the inability to run, perform push-ups and had trouble with regular activities of daily living (ADL).  His physical examination (PE) revealed a significantly antalgic gait while using one or two canes for support.  His hip range of motion (ROM) was decreased and painful.  The provider indicated that the CI’s left hip “was incredibly irritable; more so with external rotation and very irritable with an impingement maneuver including flexion, adduction, and external rotation.”  The commander’s non-medical assessment recommended medical separation.  At the VA Compensation and Pension (C&P) examination performed on 02 June 2008 (2 month after separation), the CI reported frequent left hip dislocations and chronic pain with flare-ups 3 to 4 times per week with a duration of up to 2 to 3 days.  His PE revealed a limping gait and severe limited and painful motion.  He did not use any assistive devices for walking.  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/MEB) ~5 Mo. 
Pre-Sep
	VA C&P ~2 Mo. Post-Sep
 	Ortho ~4 Mo. Post-Sep
 	
Flexion (125 Normal)	80	30	80	
Extension (20)	0	5	0	
External Rotation (45)	--	5	30	
Abduction (0-45)	20	30	30	
Adduction (45)	--	10	20	
Comment	painful motion	painful motion	antalgic gait	
§4.71a Rating	10%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition at 10% analogously rated under 5003 (degenerative arthritis) whereas the VA rated 30% under code of 5252 (limited thigh flexion).  The Board members first acknowledged that the ROM values reported by the VA examiner were significantly less than those reported by the MEB examiner 3 months prior and improvement to previous levels just 2 months later.  There were no records of recurrent injury, additional treatment modalities, or other developments in explanation of the vacillating ROM measurements within a 9 month period encompassing both before and after separation.  Board members extensively discussed and considered examination probative value (PV) in this case.
  
Board member consensus remained unclear on the reasoning for such a decline in ROM.  The closeness of the VA examination to the service separation date clearly supported a greater apportionment of PV in this case.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 20% for left hip condition based upon limitation of hip flexion at 30 degrees.  Absent worsening degree of ROM, fracture, or mal-union with marked disability, there were no alternate or analogous codes that would yield a rating greater than the recommended 20%.

BOARD FINDINGS: In the matter of the left hip condition, the Board majority recommends a disability rating of 20%, coded 5252 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The single voter for dissent recommended no modification of the PEB’s decision and did not elect to submit a minority opinion.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Impingement Syndrome Left Hip 	5252	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140405, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 9 Apr 16 ICO XXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 1 Apr 16 ICO XXXXXXXXXXXXXXX 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (h) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10%) effect date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.