RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02177
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Military Police, medically separated for “bilateral hip pain” with a disability rating of 20%.

CI CONTENTION:  “Please consider all 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 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 - 20020621	VARD - 20030514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	20%	Bilateral Hip Bursitis…	5250-5024	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported slipping during physical training and dislocating her right hip in September 2000.  A note dated 29 September 2000, recorded the CI’s complaint of right hip pain for 4 days.  On examination, she had an antalgic gait and positive testing for hip pathology with tenderness to palpation in the right inferior pubic ramus (IPR) area.   In June 2001, the CI complained of pain in the right hip with ambulation and running.  The examiner documented full range of motion (ROM), pain with legs crossed, and no pain with flexion; a clunk test (to determine femoral head relocation) was positive.  Hip x-rays were normal on 19 June 2001 without evidence of arthritic/inflammatory changes or congenital dislocation.  Magnetic resonance imaging (MRI) indicated tenosynovitis in the obturator tendon area of the right hip.  Orthopedic evaluation revealed positive loose hips with voluntary subluxation.  

The NARSUM examiner, on 28 November 2001, noted the CI injured her bilateral hips during basic training and mountain training.  She had a full ROM of the hips with a negative Faber’s test (to determine hip pathology).  Despite treatment, the hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “bilateral hip subluxation” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2001, 7 months prior to separation, the CI reported bursitis in the hip areas.  The medical examiner noted chronic spontaneous bilateral hip subluxation.  

No VA Compensation and Pension (C&P) examination was performed within 12 months of separation but the 2003 VA Rating Decision (VARD) was based on service medical records and the MEB examination finding of bilateral hip bursitis secondary to frequent subluxation.  At a VA C&P examination in 2004, the CI had a full ROM of the bilateral hips with flexion 125 degrees, extension 30 degrees, abduction 45 degrees, and adduction 20 degrees with normal internal/external rotations.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating using code 5099-5003 (degenerative arthritis) for bilateral hip pain with a history of injury.  The VA assigned a 0% rating using code 5250-5024 (hip ankylosis- tenosynovitis) for bilateral hip bursitis secondary to frequent subluxations since the CI did not appear for a scheduled examination; however, a VARD in July 2004 assigned a 10% rating using code 5024 for left hip bursitis and a 10% rating using code 5024 for right hip bursitis.  

The PEB combined the bilateral hip pain condition as a single unfitting condition coded 5099-5003 and rated 20%. The approach by the PEB commonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

The evidence for the bilateral hip pain condition was presented together above.  In this case, a bilateral condition was noted in the profile, and the bilateral hip pain condition was implicated by the NARSUM and by reference to the permanent physical profile in the commander’s statement.  Members agreed that each hip condition is separately unfitting, although the right hip was reported more frequently to be symptomatic, and identical coding and ratings are applicable.  The Board sought a route for a higher rating, but was unable to do so in the absence of hip ankylosis (5250), thigh limitation of extension (5251) or flexion (5202), thigh impairment (5253), or hip flail joint (5254).  Members discussed femur impairment (5255), but there was neither a fracture nor malunion of the femur.  The closest analogous code that was considered was malunion with slight knee or hip disability at 10% for each hip; however, that did not afford any benefit to the CI.  The members also discussed whether either of the hips or both of the hips rose to the level of a moderate disability at a 20% rating for each hip, but agreed they did not, especially since the ROMs were normal and there was no surgery or evidence of any significant degeneration of either hip joint.  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 bilateral hip pain condition.  

BOARD FINDINGS:  In the matter of the bilateral hip 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.  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 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXX, AR20160008540 (PD201402177)

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