RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02473
BRANCH OF SERVICE:  Army	BOARD DATE:  20150224
SEPARATION DATE:  20090319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Basic Trainee) medically separated for left hip pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left hip pain with healing left femoral neck stress fractures” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “left hip pain” as unfitting, rated 10% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Left ankle. Left hip. Lower back mess up was not rate by VA but was agravet [sic] by injury.”

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 (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:

IPEB – Dated 20090304	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5299-5255	10%	Residuals, Left Femoral Neck Fracture	5255	20%	20090504	
Other x 0 (Not In Scope)	Other x 8 	
RATING 10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090731 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Left Hip Pain.  The narrative summary notes the CI developed left hip pain during basic training.  Radiographs of the pelvis were normal and a bone scan on 22 May 2008 noted an early stress fracture of the left femoral neck.  The CI was placed on 30 days convalescent leave followed by physical therapy for rehabilitation.  The CI improved in a few weeks and was able to pass an Army physical fitness test.  He was returned to basic training and after a week the CI’s hip pain returned.  Radiographs of the femur and magnetic resonance imaging (MRI) of the pelvis in September 2008 noted stress fractures of the femoral neck and a stress reaction of the shaft of the femur.  Orthopedic evaluation on 25 September 2008 placed the CI on 90 days non-weight bearing on the left leg.  At a follow-up orthopedic visit on 10 December 2008 the CI reported continued hip pain aggravated by weight bearing activities and an MEB was initiated.

At the MEB examination on 23 January 2009, 2 months prior to separation, the CI reported constant hip pain rated 5/10, increased to 8/10 with weight bearing activities.  The MEB physical exam noted a normal gait and tenderness to palpation (TTP) of the hip without snapping, clicking or locking of the hip noted with range-of-motion (ROM).  There was no TTP of the greater trochanter of the femur or pain of the femur shaft with bony compression.  Strength and sensation of the left lower extremity were normal.  Physical therapy measured ROM for the MEB on 15 September 2008 noted hip flexion of 90 degrees (normal 125), abduction of 29 degrees (normal 45), and extension of 10 degrees (normal 20), with painful motion noted and decreased ROM with three repetitions of flexion of 85 degrees and abduction of 20 degrees.  The MEB examiner noted that the hip pain should slowly improve as the stress fracture heals, but that it may take up to a year.

At the VA Compensation and Pension (C&P) Joints examination on 4 May 2009, 2 months after separation, the CI reported chronic hip pain increased with weight bearing activities with stiffness, weakness, instability, and incoordination of the hip.  He did not use a cane or a crutch.  The exam noted an antalgic gait and ROM of flexion of 75 degrees, abduction to 40 degrees, and extension of 25 degrees with painful motion and decreased ROM after repetition of flexion of 70 degrees.  The examiner noted the CI could cross the left leg over the right and could toe out greater than 15 degrees on the left side (with difficulty with weight bearing).  The exam noted that the CI was unemployed; and, that his usual occupation was as a truck driver and the left hip pain impaired his ability to drive a truck.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB coded the left hip condition 5299-5255 (analogous to femur impairment) and rated 10% for slight hip disability and the VA coded 5255, but rated 20% for moderate hip disability.  The Board noted that the rating criteria of 5255 are subjective and specified as 10% for “slight,” 20% for “moderate,” and 30% for “marked” hip disability due to femur impairment, with higher evaluations for nonunion of the femur.  Members considered that the MRI did not identify any other abnormality of the hip and the MEB examiner, who was the CI’s treating orthopedic specialist, indicated that the stress fracture may take a prolonged period of time to resolve, but should gradually improve as the fracture heals.  The C&P examiner noted continued symptoms which impacted the CI’s daily activities; however, this was approximately 3 months after the MEB exam and still within the identified period of convalescence for the stress fracture.  Member consensus was that the permanent disability due to the stress fracture was best described as slight and not moderate.  The Board reviewed to see if a higher evaluation was achieved with any other applicable §4.71a code, but there was no evidence of nonunion, a flail joint, ankylosis, or compensable limitation of thigh flexion or extension.  The C&P examiner noted that the CI was able to toe out greater than 15 degrees, but added “with difficulty” with weight bearing.  The Board noted that alternatively rating for this as 5253 (thigh impairment) also provided a 10% rating, and there was no evidence of abduction limited to 10 degrees for the next higher evaluation of 20%.  Thus, the Board majority concluded that there was no path to a higher evaluation than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left 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.  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 left hip condition and IAW VASRD §4.71a, the Board by a majority vote recommends no change in the PEB adjudication.  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 20140520, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX AR20150010619 (PD201402473)

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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA