RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03359
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “bilateral hip pain,” with a disability rating of 0%.

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 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:  

SERVICE PEB - 20050112	VARD - 20060303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	0%	Bilateral Inferior Pubic Rami Stress Fractures	5299-5255	0%	20050623	
Status Post Pneumonia	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in August 2004 while in basic training.   Radiographic (X-ray) studies of the pelvic on 30 August 2004, noted a 2-week history of right hip pain and showed bilateral, right greater than left, healing stress fractures of the hips.  The CI was treated with medications, duty limitations, and physical therapy (PT).  Follow up X-ray studies on 5 October 2004 noted that the stress fractures were healing.  Multiple PT examinations during October and November noted a normal gait and full range of motion (ROM).  A PT note dated 8 November 2004 documented that the CI was able to run 1 ¼ miles on a treadmill.  Despite treatment, the bilateral hip pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bilateral inferior pubic ramus stress fractures” for PEB adjudication.  The MEB NARSUM examination on 9 December 2004 (4 months prior to separation) noted that the CI had normal gait and ROM of the hips was pain free, but reduced with flexion of 90 degrees on the right and 100 degrees on the left (normal is 125).  

At the 23 June 2005 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported that she walked a mile every day and worked in a video store.  She reported “occasional hip pain and pain with standing for as long as three hours and with cold weather.”  The hips were slightly tender to touch. The ROM was reduced in some planes, but nearly normal.  The joints were not painful on motion. There was no additional limitation following repetitive use and no additional limitation during flare-up.  The examiner noted that the CI essentially had a normal examination with minimal disability.  The X-rays were normal with no evidence of fracture or dislocation in either hip.  At the 5 January 2006 VA C&P neurology examination, performed 9 months after separation, the examiner reported that the CI does not have any symptoms related to her hips, no hip pain, and a normal gait.  Both hips demonstrated normal ROM and no pain associated with hip movement.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition at 0%, coded 5099-5003 (analogous to degenerative arthritis), citing normal motion.  The VA also rated the hips at 0%, but used the analogous code 5299-5255 (impairment of the femur).  The Board noted that the CI demonstrated the expected healing after her activity level was reduced and had a normal examination 9 months after separation.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by both the PEB and VA.   After due deliberation, considering all of the evidence and mindful of VARSD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hip pan condition.     

Contended PEB Conditions:  Status Post Pneumonia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Pneumonia is an infection from which full recovery is expected after treatment.  It was not profiled or judged to fail retention standards.  There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 “status post pneumonia” condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification and did not elect to submit a minority opinion.  In the matter of the contended pneumonia condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140621, w/attachments
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 AR20160011328 (PD201403359)

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