RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02122
BRANCH OF SERVICE:  Army	Date of seperation: 20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Automated Logistics Specialist, medically separated for “left hip and groin pain” with a disability rating of 0%.

CI CONTENTION:  Contends back, hips, pelvic and knee pain conditions.  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 based upon a 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 - 20040816	VARD - 20041112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip and Groin Pain	5099-5003	0%	S/P Stress Fracture, Left Inferior Pubic Rami	5299-5255	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Hip and Groin Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin/hip condition began in March 2004 after falling onto his gluteus area while exiting the back of a vehicle or alternatively during a road march.  Pain increased despite some relief from nonsteroidal anti-inflammatory drugs and crutches.  Left hip X-rays dated 26 March 2004 were normal, but based on a bone scan dated 29 March 2004, the CI was diagnosed with a left inferior pubic ramus stress fracture.  He was placed in physical therapy (PT) through July 2004 at which time a PT note indicated the stress fracture had healed based on X-ray findings.  Additionally, the CI had profiles and two convalescent leave periods for a total of 28 days.  Despite treatment, the groin/hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  The MEB forwarded “left groin pain secondary to inferior pubic rami stress fracture” for PEB adjudication.

At the MEB NARSUM examination dated 26 July 2004, 1 month prior to separation, physical examination of the left hip revealed full active range of motion (ROM) with pain at the extremes of motion especially with internal and external rotation with an axial load.  The CI had 5/5 strength and was neurovascularly intact distally.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 2 August 2004, less than 1 month prior to separation, the CI reported a fractured pelvic bone and use of a cane.  Physical examination noted an antalgic gait and the CI walked with a cane.  There was tenderness to palpation of the upper third of the medial thigh due to a stress fracture of the inferior pubic ramus.

No VA Compensation and Pension (C&P) examination was performed prior to or after separation until 30 July 2009, 5 years post-separation, at which time flexion of the left hip was normal at 125 degrees.  However, because of the remoteness of the examination, it offers little to no probative value.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating, analogously coded 5099-5003 (degenerative arthritis) based on the US Army Physical Disability Agency’s pain policy rated for minimal, frequent pain.  The VA assigned the left hip condition a 10% rating, analogously coded 5299-5255 (femur, impairment with slight malunion of the hip disability) based on the CI’s STR, citing painful motion.

Board members discussed a 10% rating using code 5099-5003 since the CI had noncompensable ROMs, but had pain at the extremes of motion IAW VASRD §4.40, VASRD §4.45, and VASRD §4.59.  Board members were unable to find a route to a higher rating than 10% in the absence of moderate hip disability (5255 code), hip ankylosis (5250 code), thigh impairment (5253 code) or hip, flail joint (5254 code).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left hip and groin condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the left hip and groin condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Left Hip and Groin Pain	5099-5003	10%	

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

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 AR20160014860   (PD201402122)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA