RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03061
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “bursitis left hip,” with a disability rating of 10%.

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 - 20080919	VARD - 20131219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bursitis Left Hip	5019	10%	Left Hip Bursitis	5252	*10%	20131120	
Adjustment Disorder with Mixed Emotional Features	Not Unfitting	Acquired Psychiatric Disability…	9411	100%	20131120	
Attention-Deficit Disorder	Not Unfitting	No VA Placement	
Mild Cervical Dysplasia	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	
**Deferred rating based on 2013 examination, 5 years post separation.

ANALYSIS SUMMARY:  

Bursitis Left Hip.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first evaluated for left hip pain on 15 March 2006.  She reported symptoms for the prior 10 months which was aggravated by activity.  On examination, motion was painful and decreased.  She was treated with duty restrictions and medications.  A bone scan showed minimal increased activity in the left hip thought by orthopedics to show a stress reaction rather than a stress fracture.  X-rays were normal as was an MRI.  She was then referred to physical therapy (PT), but her pain persisted.  A repeat MRI on 7 June 2007 was also normal.  An MRI arthrogram (dye study of the joint) suggested a small tear of the cartilage lining of the hip (labrum).  In an orthopedics examination on 30 August 2007, she had full range of motion (ROM) without pain and a click (associated with a labral tear) was not present.  She was tender over the top of the femur (greater trochanter) and thought to have bursitis.  A bone density scan showed that her bone density was greater than average for her demographic group.  A repeat X-ray on 21 March 2008 was again normal.  In orthopedics the same day, she reported that her pain returned whenever she increased her activity and she did not think that she would ever be able to meet the running requirements of active duty.  She had pain with motion and was tender over the greater trochanter.  A P3 profile was issued and she was referred for an MEB.  The MEB forwarded left hip pain with bursitis for PEB adjudication.  

At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 18 April 2008, 9 months prior to separation, the CI reported left hip pain with running, jumping, and carrying heavy weights, and with cold weather.  On examination, her gait was normal as was motion other than in flexion.  She could toe out over 15 degrees and cross her legs.  There was no further loss of motion with repetition.  She was tender over the greater trochanter.  Atrophy was absent.  The MEB NARSUM examination was dated 11 July 2008, 6 months prior to separation.  The CI reported left hip pain beginning in basic training which was treated with duty restrictions and medications.  She then did well until November 2005 when her pain recurred during field training.  Despite treatment, she could not perform impact activities.  The physical examination showed full ROM which did not decrease with repetition although she did have an increase in pain.  The ROM was full, but painful.  With repetition, pain increased but there was no additional limitation in the ROM.  

The VA Compensation and Pension (C&P) evaluation was not performed until 10 December 2013, almost 5 years after separation and, therefore, not probative for rating purposes at separation.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Hip (Thigh) ROM
(Degrees)	MEB ~9 Mo. Pre-Sep	PT ~9 Mo. Pre-Sep	NARSUM ~6 Mo. Pre-Sep	
Flexion (125 Normal)	Decreased	125	125	
Extension (20)	Full	20	20	
External Rotation (45)	Toe out >15 degrees	Not recorded	Toe out >15 degrees	
Abduction (0-45)	Full	45	45	
Adduction (45)	Can cross legs	Not recorded	Can cross legs	
Comment	Nml gait	Mechanical limitation	Pain with motion	
§4.71a Rating	undetermined	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip bursitis condition 10% coded 5019 (bursitis), citing painful motion.  The VA also rated the left hip bursitis condition 10% coded 5252-5019 (limitation in flexion and bursitis), based on the VA C&P examination 5 years remote from separation.  The documented limitation in motion was not compensable.  Radiographic studies were normal other than an initial bone scan and an MRI arthrogram showing a possible labral tear which was not seen on two follow-up MRIs.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 left hip bursitis condition.  

Contended PEB Conditions:  Adjustment Disorder with Mixed Emotional Features, Attention Deficit Disorder, and Mild Cervical Dysplasia.  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.  In addition, the PEB noted that the adjustment disorder with mixed emotional features and attention deficit disorder were not ratable although each could be administratively unfitting.  The Board noted that, although not specifically cited, this is IAW DoDI 1332.38 E.5.1.2.9.4.  and DoDI 1332.38 E.5.1.2.4.  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 left hip bursitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with mixed emotional features, attention deficit disorder, and mild cervical dysplasia conditions, the Board unanimously recommends no change from 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 20140627, 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 
XXXXXXXXXXXXXXXXXX, AR20160017156 (PD201403061)

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