RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02100
BRANCH OF SERVICE:  Army	BOARD DATE:  20150210
SEPARATION DATE:  20080224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Indirect Fire Infantryman) medically separated for a labral tear of the right hip.  The condition 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 hip condition, characterized as “right hip pain secondary to right hip labral tear” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated chronic right hip pain as unfitting rated 10% citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.  In order to comply with the National Defense Authorization Act of 2008, a subsequent USAPDA administrative correction was made to the IPEB modifying the condition description in the IPEB disability description and rated it with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  This correction was made after the CI was separated; however, the correction did not alter the IPEB’s rating.

CI CONTENTION:  “Please consider all conditions.”

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:

USAPDA Admin Correction – Dated 20090227	VA - (~7 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Labral Tear, Right Hip	5099-5003	10%	Right Hip Degenerative Joint Disease (Claimed as Wide
Spread Pain Syndrome, All Joints)	5099-5025	10%	20080909	
Other x 0 (Not In Scope)	Other x 22	
Rating:  10%	Combined:  70%	
Derived from VA Rating Decision (VARD) dated 20080930 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Labral Tear, Right Hip.  According to service treatment records, the CI developed right hip pain during training in April 2006 which was aggravated during a deployment.  Magnetic resonance imaging (MRI) arthrography (MRI with contrast injected into the joint space) performed on 6 March 2007, demonstrated a small partial tear of the superior labrum, the cartilage rim of hip joint socket in the pelvis.  Orthopedic evaluation concluded with recommendation for non-surgical treatment.  The CI continued to experience right hip pain preventing return to military duties.  The MEB narrative summary examination noted pain with use of the hip, tenderness to palpation and limitation of motion.  Physical therapy range-of-motion examinations dated 17 September 2007 and 19 September 2007 recorded respectively, active flexion of 80 and 60 degrees, extension of 10 and 0 degrees, abduction of 15 and 12 degrees, adduction 20 degrees and able to cross legs, external rotation 40 degrees and able to toe out more than 15 degrees.  At the VA Compensation and Pension (C&P) examination on 9 September 2008, 6 months after separation, the CI reported persistent hip pain with use.  On examination, right hip flexion was 90 degrees, extension 30 degrees, abduction 30 degrees, adduction 15 degrees, internal rotation 30 degrees and external rotation 40 degrees.  Pain was reported with motion.  Hip and thigh strength was normal.  The examiner noted that there was no objective clinical evidence that function was additionally limited by pain, weakness, incoordination or lack of endurance.  X-rays at the time of the VA C&P examination reported presence of degenerative joint changes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip labral tear and pain 10% coded 5099-5003 (degenerative joint disease) citing pain and functional loss.  The VA rated the right hip condition (degenerative joint disease claimed as widespread pain, all joints) 10% citing pain and functional loss.  The limitation of right hip motion recorded in the examinations did not support a minimum rating under the diagnostic codes for limitation of hip motion (5251, 5252, and 5253).  Although one physical therapy examination which recorded limitation of extension was sufficient to support a 10% rating, all other examinations did not show limitation of extension.  However, evidence of the record supports the 10% rating for functional loss.  There was no evidence to support a higher rating than 10%.  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 labral tear with 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.  In the matter of the right hip labral tear and 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 20140510, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX     
President 
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, AR20150010478 (PD201402100)

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