RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02108
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 Supply Specialist medically separated for chronic bilateral hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic bilateral hip pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded adjustment disorder/occupational problem for PEB adjudication.  The Informal PEB adjudicated “chronic bilateral hip pain” as unfitting, rated 0%.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.  

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 Veterans Affairs Schedule for Rating Disabilities 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 20030725	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5099-5003	0%	Chronic Bilateral Hip Disability	5255	0%	20031001	
Adjustment Disorder/Occupational Problem	Not Unfitting	Not Addressed	
Other x 0 (Not In Scope)	Other x 2	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20040525 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Bilateral Hip Pain Condition.  Treatment records evidence that the CI presented with left hip pain with sit-ups in February 2002.  She was treated with activity modification and anti-inflammatory medication.  X-rays and a bone scan evaluation of the left hip and femur demonstrated mild degenerative joint disease at the left hip socket and a cystic bone legion in the left distal femoral shaft.  An orthopedic evaluation dated 7 March 2002 noted reports of hip and groin pain on rotation.  Bilateral hip pain was assessed.  At an orthopedic evaluation dated 25 October 2002 the CI reported bilateral hip pain with popping of the right hip.  The CI was treated with physical therapy activity modification, and anti-inflammatory medication without relief.  On physical examination the CI had a normal gait, full active hip range-of-motion (ROM), tenderness to palpation localized to the lateral hips, and right hip snapping.  Diagnoses of chronic bilateral hip pain, snapping right hip, and fibroma of the left distal femur were rendered.  The orthopedist opined that the CI was not a surgical candidate.  At the narrative summary (NARSUM) the CI reported constant dull hip pain with sitting and pinching/sharp pain with ambulation.  She report that she could not walk greater than 100 yards or climb more than two flights of steps with increased pain.  She also reported crutch ambulation when in a “tremendous amount of pain.”  The physical examination demonstrated no hip tenderness to palpation bilaterally, decreased hip flexion and adduction bilaterally, and normal motor strength.  The examiner noted that the CI was pregnant.  A diagnosis of chronic bilateral hip pain was rendered.  

At the VA Compensation and Pension (C&P) exam performed 3 months after separation, the CI reported right greater than left hip pain with walking and when sleeping and that she could pop the right hip in and out.  The pain was worse with climbing stairs and uphill ambulation.  She was did not take pain medication for her hips and did not use any assistive devices for ambulation.  On physical examination her gait was normal, there was a popping noise on the right hip with internal and external rotation. The examiner noted a reported diagnosis of bilateral hip arthritis and necrosis.  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/Right Hip (Thigh) ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
(20030213) 	VA C&P ~3 Mo. Post-Sep
(20031001) 	
Flexion (125 Normal)	120	120	125	125	
Extension (20)	30	30	30	30	
External Rotation (45)	40	40	45	45	
Abduction (0-45)	45	45	25	45	
Adduction (45)	25	25	45	45	
Comment	No tenderness or painful motion	Normal x-rays; No tenderness or painful motion	
§4.71a Rating	0%	0	0%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the bilateral hip pain condition at 0%; coded 5099-5003 (degenerative arthritis) and 5255 (femur impairment of) respectively.  Both hips were profiled and profile limitations were implicated in the commander’s statement.  Board member’s agreed that each hip could be reasonably justified as separately unfitting.  The Board considered whether the evidence supported a higher than 0% rating for either hip.  Although there was pain with use, both the NARSUM and VA examination documented no tenderness to palpation, painful motion, or pain limited motion.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 0% for the bilateral hip pain condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the adjustment disorder was 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 adjustment disorder was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  Primary care treatment notes listed adjustment disorder, occupational problems, partner relational problem, manic-depression, bipolar disorder, and post-traumatic stress disorder; however, mental health treatment notes were not available for Board review.  The NARSUM listed adjustment disorder/occupational problem as evaluated and treated by Community Mental Health.  At the VA C&P PTSD evaluation performed 8 months after separation; the CI reported feeling down “every now and then.”  She reported that she was not on any psychotropic medications.  She denied prior manic symptoms and current symptoms of depression.  The mental status examination was normal with a Global Assessment of Functioning score of 72 (If symptoms are present they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning).  A diagnosis of dysthymic disorder was rendered.  The examiner opined that the CI did not meet criteria for post-traumatic stress disorder, manic-depressive disorder, or bipolar disorder.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that adjustment disorder 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 adjustment disorder contended condition and so no additional disability rating is 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 chronic bilateral hip pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder condition, the Board unanimously recommends no change from the PEB determination 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 20140422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA   22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160002801  (PD201402108)

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 1O, 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 ( ) OVA