RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03361
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020430 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Heavy Wheel Vehicle Mechanic, medically separated for “bilateral trochanteric bursitis,” 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 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 - 20020325	VARD - 20020517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Trochanteric Bursitis	5019	0%	Iliopsoas Bursitis of the Right Hip	5019	10%	20020425	
			Iliopsoas Bursitis of the Left Hip	5019	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:    

Bilateral Trochanteric Bursitis.  The service treatment records (STR) documented an atraumatic onset of left hip pain in 1999.  The CI was treated for chronic left hip pain over the ensuing period to separation, but clinical notes did not relate a complaint of right hip pain until a strain injury in October 2001 (6 months before separation).  She was eventually diagnosed with bilateral bursitis (suggestive bone scans, negative X-rays and MRI).  The MEB identified “bilateral hip trochanteric bursitis” for PEB adjudication.  There was no STR documentation of gait disturbance or incapacitation.  There were numerous STR entries that documented grossly normal range of motion (ROM).  There was an orthopedic entry in December 2001 (5 months before separation) that recorded bilateral flexion to 120 degrees (normal 125, 45 for minimum 10%) and external rotation to 30 degrees (normal 45, 15 for minimum 10%).  There were no entries indicating more significant ROM limitation.  Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for a Medical Evaluation Board (MEB) which in turn forwarded “bilateral hip trochanteric bursitis” to the Physical Evaluation Board (PEB). 
  
The narrative summary (NARSUM) examination on 8 February 2002 (3 months before separation) described bilateral hip pain which had begun soon after childbirth and was now improving with injections, rated 3/10, and rendering the CI “unable to march, run, or stand for long periods of time.”  The physical examination recorded “mild” tenderness, full strength, and “full” ROM with bilateral flexion to 120 degrees.  The commander’s performance statement did not provide evidence probative to separate fitness implications of either hip (or whether unilateral or bilateral), and the profile was for “right and left hip pain.”  

A VA Compensation and Pension (C&P) examination on 25 April 2002 (5 days before separation) documented the same history of bilateral hip pain commencing with childbirth as reported at the NARSUM.  It was rated 4/10 with exacerbations to 10/10, “worse with walking and any running.”  The physical examination noted an antalgic gait “secondary to foot pain” and tenderness.  The recorded ROM measurements (all bilateral) were flexion to 125 degrees, extension to 0 degrees (normal 20, 5 for minimum 10%), external rotation to 30 degrees, abduction to 45 degrees (normal), and adduction to 30 degrees (normal 45, “cannot cross legs” [~10 degrees] for minimum 10%); without notation of painful motion or pain thresholds.  Of note the examiner recorded bilateral internal rotation of 90 degrees, impossible for a normal joint; thus, posing a probative value issue for the VA ROM evidence.  This same reservation included the recorded 0-degree extension which would reflect a severe limitation nearly impossible to have gone unnoticed by the numerous examiners documenting normal ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s bilateral 0% rating likely rested on application of AR 635-40 as above; but, a bilateral rating of 0% does not comport with VASRD §4.71a which confers a 10% rating under 5003 for the involvement of “2 or more major joints” without specifying a need for additional criteria.  The VA’s separate 10% ratings were under code 5019 (bursitis, defaulting to criteria of 5003) and premised on the C&P findings.  Members first agreed that the C&P evidence for separately compensable ROM limitation (extension) was insufficiently probative (as elaborated above) to underpin a Board recommendation for separate ratings solely on that basis.  The evidence did not otherwise support a compensable rating under any of the codes for limitation of motion; and, there was no ankylosis, fracture deformity, or instability that would achieve separate ratings higher than 10%.  

The Board was thus left with deciding whether the hips were reasonably justified as separately unfitting as a basis for recommending a bilateral 10% or separate 10% ratings.  From the STR evidence in this case, the question was raised as to whether the left hip complaint would have itself precipitated a MEB referral; but, it remained that the NARSUM, the MEB’s DA Form 3947, and the profile implicated both joints.  Members agreed; however, that given the pathology and clinical acuity described above, it was reasonable to conclude the performance limitations confined to either hip alone would not have rendered the CI incapable of continuing military service; and, more likely it was the combined effect of the bilateral condition which rendered her unfit.  Members thus agreed a bilateral 10% rating under 5003 was appropriate.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the bilateral hip condition under code 5019 (defaulting to criteria of 5003).  

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 5019 IAW VASRD §4.71a.  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	
Trochanteric Bursitis, Bilateral Hips	5019	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140702, 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 XXXXXXXXXXXXXXXXXX AR20160014201 (PD201403361)

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