RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01807
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Unit Supply Specialist) medically separated for a left HIP condition.  The condition could not be adequately rehabilitated to satisfy the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left hip condition, characterized as “left hip chondromalacia,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  Two other conditions (upper back pain and headaches) were submitted by the MEB.  The Informal PEB adjudicated “left hip pain,” as unfitting, rated 10%, with citied 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 requests consideration of all conditions in her application.  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/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 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 20080814	VA* - (~2 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5299-5255	10%	Left Medial Femoral Neck Stress Fracture with ORIF and DJD 	5253	10%	20080813	
Upper Back Pain	Not Unfitting	Upper Back Muscular Strain	5237	0%		
Headaches		Tension Headaches	8199-8100	**NSC		
Other Conditions x 0 (Not In Scope)	Other X 5 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090106 (most proximate to date of separation [DOS]).  **Not Service Connected.

ANALYSIS SUMMARY:  

Left Hip Pain Condition.  In December 2004, the CI was radiographically diagnosed with a left sided hip stress fracture that eventually became a near complete fracture of the femoral neck (hip area) which required surgical pinning in January 2005.  Post-operatively, she did well with restrictions and physical therapy (PT) and eventually was diagnosed with a “healed stress fracture” of the left hip.  Upon the resumption of running activities, she again developed left hip pain.  Repeat X-rays did not reveal any interruption of the surgically placed fixation screws.  She was diagnosed with a chronic bursitis and degenerative arthritic changes in the left hip.  Subsequent to the chronicity of her condition, she was permanently profiled in October 2007 and referred to a MEB.  

At the MEB narrative summary (NARSUM) examination performed on 9 February 2008; 8 months prior to separation, the CI endorsed continued diffuse left hip pain with “popping” and “clicking” upon movement.  She additionally stated the inability to run, ruch, or road march due to pain.  Her physical examination (PE) range-of-motion (ROM) of the left hip was measured on 27 May 2008 (5 months prior to separation) and was decreased and painful.  Tenderness about the left hip was present.  There was no palpable click or crepitus noted.  Neurological components of motor control and sensation were normal.  The examiner documented the presence of pain as the limiting factor for ROM extremes.  

At the VA Compensation and Pension (C&P) examination on 13 August 2008; 2 months prior to service separation), the CI reported continued “achiness” in her left hip joint.  She also indicated that she “…recovered most if not all of the function of the leg and hip joint.”  The PE revealed limited and painful motion of the left hip.  She was not able to actively cross the left leg over the right.  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)	MEB/PT~5 Mo. Pre-Sep
(20080527) 	VA C&P ~2 Mo. Pre-Sep
(20080813) 	
Flexion (125 Normal)	100	120	
Extension (20)	15	15	
External Rotation (45)	-	-	
Abduction (0-45)	35	40	
Adduction (45)	‘able to cross legs’	‘only able to get foot on top of opposite knee’…in attempt to cross legs.	
Comment	painful motion	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.    Board members first agreed that both the pre separation MEB/PT examination as well as the VA examination offered near equal probative value in this case.  Clearly, the evidence of consistent painful motion as well as limited adduction found at the VA examination support the maximum of 10% IAW VASRD §4.59 or §4.71a.  Absent persistent fracture without nonunion or malunion and or the presence of hip disability greater than “slight,” there is no route to an impairment rating higher than the PEB’s current 10%.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the left hip condition was appropriately recommended in this case.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the upper back pain and headache 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.  The back pain or headache condition were not profiled or specifically implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  The case file contained two clinical encounter documents that pertained to back pain during the period of 2007 and 2008 each resulting in the disbursement of medication without restriction of activity.  Her headache condition was noted to occur “several times a week” which were completely resolved within 3 minutes of taking over the counter Advil medication.  Board members deliberated and concluded that there was no performance based evidence contained in the case file that neither of these conditions significantly interfered with satisfactory duty performance and therefore, agree not to recommend a change in the PEB’s fitness determination. 

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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended upper back pain and headache condition, 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 20140421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

06 JUl 2016

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, AR20160003405 (PD201401807)

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