RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02329
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Trainee) medically separated for bilateral pelvic/hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic bilateral pelvic pain secondary to inferior pubic rami (IPR) stress fractures,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral pelvic/hip pain secondary to IPR stress fractures” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  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 20071002	VA* - (~27 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Pelvic/Hip Pain	5099-5003	0%	Degenerative Joint Disease (DJD) of the Left Hip	5010-5252	10%	20100208	
			DJD of the Right Hip		10%		
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20100408 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Bilateral Pelvic/Hip Pain.  The narrative summary (NARSUM) related a 4-month history of bilateral hip pain which developed while in basic training and progressed in symptomatology despite multiple clinic visits, multiple medications and physical therapy (PT).  Plain X-rays suggested and a bone scan confirmed a left IPR stress fracture.  There were no other hip or pelvic abnormalities seen on the scan.  Repeat radiographs performed on 30 August 2007 revealed normal hips and progressive healing changes within the left IPR stress fracture.  Due to persistent complaints of hip pain, she was permanently profiled with a listed diagnosis of chronic bilateral hip pain secondary to IPR fractures and was referred to a	n MEB.  The NARSUM was conducted on 04 September 2007 (2 months prior to separation) whereby the CI complained of bilateral anterior hip pain; left greater than right.  Her physical examination (PE) noted full range-of-motion (ROM) of her hips with tenderness of both IPR; left worse than right.  Physical therapy measured ROM (5 days prior to NARSUM) revealed decreased and painful motion of both hips with a minimum of 92⁰ of flexion (normal 125⁰; minimal compensable 45⁰) and hip extension of 5⁰ (normal 20⁰; minimal compensable 5⁰).  Her hip adduction and external rotation were not limited to minimal compensatory VASRD criteria.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating analogously to 5003 (degenerative arthritis) was supported by the USAPDA pain policy, but was not compliant with VASRD §4.71a criteria.  The VA rated both hips separately at 10% each under VASRD code 5010-5252 (arthritis due to trauma-thigh, limitation of flexion).  Board members first deliberated if the left and right pelvic area/hips, having been de-coupled from the combined PEB adjudication, remained separately unfitting and therefore subject to a rating.  The overwhelmingly objective clinical STR evidence, as well as X-ray findings were solely representative of a left-sided pelvic fracture and not actual hip pathology.  Board members deliberated and agreed that in light of minimal examination findings coupled with normal radiographs, it would be highly speculative to conclude that any disability from a right-sided pelvis/hip condition would have rendered the CI incapable of performing her military duties.  Therefore, members did not find a right-sided pelvis/hip condition as separately unfitting.  Members did agree that the pathology and clinical relevance present near the time of separation did support evidence that the left-sided pelvic stress fracture with resulting left hip pain did render her with physical restrictions making her unfit for continued military service.  All parameters of left hip ROM were considered VASRD non-compensable except for extension.  Her extension limitation of 5 degrees clearly supported the sole rating of 10% IAW VASRD code 5251 (thigh; limitation of extension).  There were no other codes available within VASRD §4.71a that were applicable to the CI’s diagnosis or disability nor documentation of incapacitating episodes which would provide for additional or higher rating.  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 separately unfitting left pelvic/hip 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.  As discussed above, PEB reliance on the USAPDA pain policy AR 635-40 DoDI 1332.39 for rating the hips was operant in this case and the condition was adjudicated independently of that policy/instruction by this Board.  In the matter of the left pelvic/hip condition, the Board unanimously recommends a disability rating of 10%, coded 5251 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	RATING	
Left Pelvic/Hip Pain 	5251	10%	
RATING 	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140521, 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 XXXXXXXXXXXXXXXXXXXX, AR20160004492  (PD201402329)

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 
( ) OVA