RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030509  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Trainee) medically separated for chronic left hip pain.  The left 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).  “Chronic left hip pain secondary to stress fracture of the left femoral neck” 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 chronic left hip pain as unfitting, rated 10%, 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 20030410	VA* - (~5 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain	5099-5003	10%	Stress Fracture, Left Hip	5299-5255	10%	20021213	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20030514 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Left Hip Pain Secondary to Stress Fracture of the Left Femoral Neck.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s left hip condition began in April 2002.  Radiographic studies showed a stress fracture and there was no surgical indication.  Despite prolonged rest and treatment, the CI’s left hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  At the time of the orthopedic clinic appointment on 22 October 2002, the CI reported improved left hip pain since onset, with ability to walk and stand without pain.  He had hip pain with running or jumping.  On examination the left hip flexion was 110 degrees (125 normal) with external rotation of 85 degrees (45 normal).  The MEB NARSUM exam on 14 November 2002 (6 months prior to separation) noted complaints of continued daily left hip pain, with significant pain on going up stairs.  The CI was no longer taking any mediation because he did not feel that it was effective.  Physical exam showed “left anterior hip pain worse with internal and external rotation of the left hip, minimal pain with full extension of the hip.”  

At the VA Compensation and Pension examination on 13 December 2002, performed 5 months prior to  separation, the CI reported a similar history with complaints of 4-8/10 left hip pain depending on activity.  Symptoms occurred almost constantly, worsening with running or jumping, and he used a cane for a few days if he engaged in activities more than a sedentary level.  Physical exam showed normal posture and gait.  There was tenderness to the left hip with range-of-motion (ROM) evaluation documenting pain-limited left hip flexion of 90 degrees (125 normal), extension 30 degrees (20 normal), abduction to 40 degrees (45 normal), and adduction 25 degrees (45 normal) with all hip ROM additionally limited by pain, fatigue, weakness, lack of endurance on repetition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative [hypertrophic or osteoarthritis]), citing the USAPDA pain policy.  The VA also assigned a 10% rating using an analogous 5255 code (femur, impairment of) citing slight hip impairment.  The Board agreed that a 10% rating, but no higher, was justified for painful limitation of ROM and slight hip functional limitation with consideration of VASRD §4.59 (painful motion).  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 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 left hip condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left 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 20140703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX AR20160004520 (PD201403328)

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