RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02758
BRANCH OF SERVICE:  Army	BOARD DATE:  20150430
SEPARATION DATE:  20031009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (M1 Abrams Tank System Maintainer) medically separated for right hip pain.  The right hip condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Right femoral neck stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the right hip pain 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:  “The pins in my leg cause my lower back to hurt.”

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 20030915	VA* - based on Service Treatment Records (STR)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Status Post-Operative Pinning of Femoral Neck Stress Fracture	5099-5003	0%	Status Post Stress Fracture with Pinning, Right Hip Femoral Neck	5299-5255	20%	STR	
Other x 0 (Not In Scope)	Other x 0	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20031023 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Hip Condition.  During basic training the CI developed right hip pain while running in March 2003.  His pain remained in the right hip and worsened with weight-bearing activities.  A magnetic resonance image revealed a right hip stress fracture described as encompassing 50% of the femoral neck boney structure.  The severity of his condition required more than restricted activity and in April 2003, he underwent surgical pinning of the fractured site.  Post-operatively, he did well whereby after 2 months he desired to re-start his basic training.  Given the high-impact of such training and the increased risk of re-injury in this case, the CI was permanently profiled and was sent for an MEB.  At the time of the MEB narrative summary performed on 7 July 2003, 3 months prior to separation, the CI’s primary complaint was right hip pain with weight bearing.  He denied numbness or tingling sensation in the right lower extremity.  The physical examination of the right hip was deferred except for range-of-motion (ROM) which was decreased in flexion to 90 degrees (normal = 125 degrees).  All other parameters of ROM were normal.  The permanent profile listed “status post right femoral neck fracture” as the sole diagnosis and the commander’s letter confirmed that the CI’s physical impairments prevented him from fulfilling the requirements of his military specialty.  His pain was described as “minimal and intermittent.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating was supported by the USAPDA pain policy and appeared to remained compliant with VASRD §4.71a criteria.  The VA rating analogously coded under 5255 (femur, impairment) yielded a 20% rating for moderate hip disability.  There was no ROM impairment present to achieve a compensable rating under applicable ROM codes.  Board members did consider and agreed with the PEB’s analogous coding approach in this case, but did not support their selected primary code or their 0% rating.  Although non-compensable, the limitation of hip flexion to 90 degrees indeed described some level of impairment.  The question for deliberation was the degree of hip disability as being “slight” at 10% or “moderate” at 20%.  There was no clinical evidence of ankylosis or nonunion/malunion of any component of the hip/thigh under VASRD §4.71a that would yield a rating greater than described above.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that “slight” (10%) disability was most accurate of the CI’s right hip condition near the time of service separation.

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 for rating the right hip was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right hip condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5255 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 his prior medical separation:

CONDITION	VASRD CODE	RATING	
Status Post Right Hip Pinning	5299-5255	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140528, 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, AR20150015567 (PD201402758)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl						     XXXXXXXXXXXXXXX										     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA