RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03090
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-4 (Unit Supply Specialist) medically separated for “chronic bilateral hip pain” with a disability rating of 0%.

CI CONTENTION:  The CI requested consideration of 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 –20040928	VARD - 20050628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5099-5003	0%	Trochanteric Bursitis, Right Hip	5255	10%	20050425	
			Trochanteric Bursitis, Left Hip	5255	10%	20050425	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Bilateral Hip Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip condition insidiously began in early 2002.  Radiographic imaging studies of both hips were normal.  Conservative treatment for her painful hip conditions did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic bilateral hip pain, left worse than right” for PEB adjudication.  At the MEB NARSUM physical examination (PE) performed on 22 July 2004, 5 months prior to separation, the CI reported bilateral hip pain.  Her PE was normal excepting painful and minimal decrease in hip range of motion (ROM).  At the 25 April 2005 VA Compensation and Pension (C&P) examination, performed 4 months after separation, the CI endorsed hip pain with walking, stooping, running, and squatting. Flare-ups occurred as often as 3 times per day with a duration of 30 minutes each episode.  Her reported functional impairments included the inability to exercise or climb stairs with flares.  Her VA PE revealed tenderness about both hips.  ROM remained decreased and painful. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB bundled and rated the bilateral hip condition analogously coded 5099-5003 (arthritis, degenerative) citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA separately rated each hip at 10% under VASRD code 5255 (Femur impairment); indicating ‘slight’ disability.  The Board’s initial charge in this case was directed at determining if the PEB’s approach of combining the bilateral hip condition as a single rating was justified in lieu of separate ratings.  The Board must apply separate codes and ratings in its recommendations if compensable ratings for each extremity condition are achieved IAW VASRD §4.71a.  If the Board judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each ‘unbundled’ condition was unfitting in and of itself.

The Board acknowledged that the sole remarkable PE finding of painful motion in both pre and post separation exams did warrant application of VASRD §4.59 for a minimum of 10% as applied unilaterally or bilaterally.  In light of a generally unremarkable PE of either hip, (excepting painful motion), members considered whether each hip could be reasonably justified as separately unfitting.  Historical evidence included that the left hip was more symptomatic than the right; however, this was not consistent throughout the STR.  Near separation, the case revealed minimal evidence which was equivocal for each hip.  Although it is speculative to conclude that the disability confined to the either hip would have rendered the CI incapable of performing within her occupational rating, member consensus was that it was also reasonable to surmise that it was the overall effect of both hips which rendered her unfit.  The Board concluded that the bilateral diagnosis did support a single 5003 based rating for “2 or more major joints,” as conferred by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), as well as §4.59, the Board recommends a disability rating of 10% for the bundled bilateral hip condition.    

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 10%, coded 5099-5003.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Bilateral Hip Pain 	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140626, 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 XXXXXXXXXXXXXXXXXXXXX AR20160017158 (PD201403090)

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
(  ) DVA