RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02264
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Information Technology Specialist, medically separated for “bilateral trochanteric bursitis” rated 10% for each hip, with a combined 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 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 - 20080929	VARD - 20090302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bursitis Described as Bilateral Trochanteric Bursitis	5019	20%	Femoroacetabular Impingement Syndrome, Left Hip (Claimed as Bilateral Hips Bursitis)	5019-5252	0%	20090117	
			Right Hip Bursitis	5019-5252	NSC		
Calcified Right Hilar Lymph Node	Not Unfitting	No VA Placement		
Low Back Pain		No VA Placement		
Bilateral Anterior Knee Pain		Right Knee Disability	5260	NSC		
		Left Knee Disability	5260	NSC		
Left Ankle Pain		Left Ankle Disability	5271	NSC		
		Right Ankle Disability	5271	NSC		
Restless Leg Syndrome		No VA Placement		
Dry Eye Syndrome		No VA Placement		
Intermittent Transient Paresthesias of Upper and Lower Extremities		Intermittent Transient Paresthesias of the Arms and Legs	8515-8520	Deferred		
Migraine Headache		Migraine Headaches	8100	Deferred		
Asthma		Asthma	6602	30%		
Allergic Rhinitis		No VA Placement		
Dysmenorrhea and Uterine Fibroids		Dysmenorrea	7699-7629	NSC		
		Uterine Fibroids	7613	NSC		
Adjustment Disorder	Not Constituting a Physical Disability	No VA Placement		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bilateral Hip Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the bilateral hip pain began in October 2007 after performing her Army Physical Fitness Test (APFT).  The MEB forwarded “bilateral hip pain due to trochanteric bursitis and mild degenerative joint disease left hip” for PEB adjudication.  A bilateral hip MRI showed premature hip joint degenerative changes (R>L) with no evidence of hip stress fractures.  The rheumatology evaluation listed multiple arthralgias (joint pains) with no real evidence for inflammatory arthritis.  The bilateral hip X-rays showed mild left hip degenerative joint disease.  At an orthopedic surgery evaluation the CI complained of 1 year of bilateral hip pain without specific injury.  The bilateral hip examination revealed diffuse hip, moderate anterior hip joint, and exquisite (L>R) greater trochanter (proximal lateral femur bony prominence) tenderness.  There was lateral pain with the impingement maneuver and straight leg adduction.  Passive range of motion (ROM) was full.  The surgeon performed a left hip injection with local anesthetic and corticosteroid which gave 100% relief of greater trochanter pain and tenderness at 5 minutes.  The diagnosis listed bilateral (L>R) trochanteric bursitis (inflammation of fluid-filled sacs between tissues).  

The MEB NARSUM examination on 5 September 2008, 2 months prior to separation, noted complaints of chronic bilateral hip pain.  The pain was exacerbated by prolonged walking, stairs, running, and impact activities.  The CI did not experience significant improvement with conservative management (activity modification, physical therapy [PT], and medications).  The physical examination showed greater trochanter tenderness and no groin tenderness, lymphadenopathy (enlarged lymph nodes), atrophy, or fasciculations (muscle twitching).  The Active ROM (AROM) was measured with a goniometer.  The right hip flexion was 80 (125 normal), extension was 10 (10), and abduction was 30 (45) degrees.  The left hip flexion was 70 (125), extension was 10 (10), and abduction was 20 (45) degrees.  There was no limitation on external rotation and the CI was able to cross her legs.  The AROM was limited by pain, but not weakness, fatigue, lack of endurance, or incoordination.  The strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  The examiner recounted the findings from the rheumatology evaluation, orthopedic surgery evaluation, X-rays, bone scan, and MRI.  The diagnosis listed bilateral hip pain due to trochanteric bursitis and mild left hip degenerative joint disease.  The serial (physical medicine and rehabilitation, rheumatology, PT, and C&P) examinations, following the NARSUM examination, documented bilateral hip ROM was “full” or “normal.”  

At the 17 January 2009 Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported intermittent bilateral lateral hip and groin pain.  She denied alleviation of her symptoms with medication.  The physical exam showed a normal gait without assistive device.  The bilateral hip exam revealed mild left greater trochanter tenderness.  Repetitive (X3) active ROM was normal and without painful limitation.  There was no additional ROM functional impairment due to pain, weakness, fatigability, or incoordination.  Strength, sensation, and DTRs were normal.  The bilateral hip X-rays were normal.  The diagnoses listed mild left hip femoroacetabular impingement syndrome and normal right hip.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the  bursitis described as bilateral trochanteric bursitis 10% coded 5019 (bursitis) rating for the right hip, and a 10% rating for the left hip, (IAW VASRD 4.25 10% + 10% = 19% plus 1.9% bilateral factor = 20.9% ~ 20%) citing ROM and limitation of motion.  The VA rated the  bursitis described as bilateral trochanteric bursitis 0% coded 5252 (thigh, limitation of flexion of), based on the VA C&P examination 2 months after separation, citing hip tenderness, full hip ROM, and no painful motion.  The VA did not service-connect the right hip based on the VA C&P citing normal ROM, no painful motion, and no evidence of a disability on objective examination.  There was no evidence of disability for consideration of rating under 5250 (hip, ankylosis of), 5251 (thigh, limitation of extension of), 5252 (thigh, limitation of flexion of), 5253 (thigh, impairment of), 5254 (hip, flail joint), or 5255 (femur, impairment of).  Members debated if 10% was warranted for each hip with application of VASRD §4.40 (functional loss) or §4.59 (painful motion).  The Board carefully considered the option of rating both hip conditions together, noting that the PEB rated each hip separately and the VA rated only the left hip.  The Board concluded that the evidence did provide sufficient grounds for recommending separate hip disability ratings in this case.  A rating of 10% for the right and 10% for the left, coded 5019, is a good analogy to both the pathology and disability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the bilateral trochanteric bursitis coded 5019.

Contended PEB Conditions.  Calcified right hilar lymph node; low back pain;  bilateral anterior knee pain;  left ankle pain; restless leg syndrome;  dry eye syndrome;  intermittent transient paresthesias of upper and lower extremities; migraine headache; asthma;  allergic rhinitis; dysmenorrhea and uterine fibroids and adjustment disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended calcified right hilar lymph node, low back pain, bilateral anterior knee pain, left ankle pain, restless leg syndrome, dry eye syndrome, intermittent transient paresthesias of upper and lower extremities, migraine headache, asthma, allergic rhinitis, dysmenorrhea, uterine fibroids and adjustment disorder conditions, 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.  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 20140516, 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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010918 (PD201402264)

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