RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03175
BRANCH OF SERVICE:  Army	BOARD DATE:  20150526
SEPARATION DATE:  20071101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Dental Specialist) medically separated for a right hip condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “right femoral neck stress fracture” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “stress fracture of the femoral neck of the right hip” 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 (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 20080701	VA* - (~7 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Stress Fracture	5099-5003	0%	Right Hip Stress Fracture	5252-5020	0%**	20080522	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080701 (most proximate to date of separation [DOS]).
**VARD dated 20090618 increased Right Hip rating to 10%.

ANALYSIS SUMMARY:

Right Hip Stress Fracture Condition.  The CI sustained a right hip stress fracture in basic training as verified by MRI and X-rays (not in evidence).  Her symptoms resolved when removed from training, but recurred once she began vigorous physical activity.  The narrative summary was dated 20 August 2007.  Her range-of-motion (ROM) was essentially normal as was her neurologic examination.  There was no atrophy and a full recovery was anticipated.  At the MEB examination on 4 September 2007, the CI reported pain with standing.  The examiner documented full active ROM.  A VARD dated 18 June 2008 noted that a VA primary care note in January 2008, 2 months after separation, documented a normal gait.  At the VA Compensation and Pension (C&P) foot examination performed on 22 May 2008, 7 months after separation, the CI reported that she had been separated while still using crutches, but that she left them at the airport en route to her home and had not used any since.  She was pain free unless she stood for over an hour or walked extensively.  She was able to dance, but needed to sit after two or three songs to rest.  The examination of the hip was essentially normal other than a slight loss of motion; however, it was improved from what had been measured on the left side at the MEB.  X-rays were normal.  A general C&P the same day noted a normal gait and posture.  A post-separation MRI on 22 May 2009 was normal, consistent with the expected resolution of the stress fracture.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Hip (Thigh) ROM
(Degrees)	MEB/PT ~2 Mo. Pre-Sep Right	MEB/PT ~2 Mo. Pre-Sep Left	VA C&P ~7 Mo. Post-Sep	
Flexion (125 Normal)	105/105/108	105/105/110	120	
Extension (20)	15/12/10	15/15/15	--	
External Rotation (45)	42/45/45	45/48/45	60	
Abduction (0-45)	22/28/28	30/38/40	40	
Adduction (45)	12/15/15	12/15/18	--	
Comment	Limited by stiffness and pain 	Unaffected side	Pain free motion	
§4.71a Rating	0%	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip at 0% using the code 5099-5003 (degenerative arthritis).  The VA also rated the right hip at 0% using the codes 5252 (thigh, limitation of motion) and 5020 (synovitis).  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right hip stress fracture 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 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 and IAW VASRD §4.71a, the Board unanimously 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 20140708, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

DEPARTMENTOFTHEARMY
ARMY  REVIEW   BOARDS   AGENCY 25118TH    STREET   SOUTH,   SUITE  385
ARLINGTON,    VA   22202-3531

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 XXXXXXXXXX,  AR20160003321   (PD201403175)

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