RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03417
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040520

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 “chronic pain, left hip” with a disability rating of 20%.

CI CONTENTION:  The CI contends for her unfitting condition and also asks for review of conditions not identified by either the MEB or PEB.  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 - 20040326	VARD - 20040607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, L Hip	5099-5003	20%	Left Hip Strain	5099-5003	20%	20040406	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Hip.  The service treatment records, the Medical Evaluation Board (MEB) narrative summary (NARSUM), and Orthopedic Addendum indicated the CI began to have left hip pain during AIT after a road march in January 2003; however, a physical therapy note indicated pain began in November 2002.  X-rays of the left hip were normal in April 2003, while a bone scan demonstrated diffuse stress change uptake at the bilateral hips, knees and ankles, but there was no evidence of pelvis or a lower extremity stress fracture.  The CI’s pain was located at the anterior hip region and radiated toward the posterior buttock while the left leg had tingling.  A sub-acute onset of low back pain without trauma was felt to be self-limiting in July 2003.  Treatment included physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), activity limitation, and muscle relaxers.  At the MEB examination dated 18 December 2003, the CI reported tingling down her left leg because of frequent left hip pain.  The examiner noted hip/groin with hip extension and flexion.  On examination for the orthopedic addendum dated 9 February 2004 there was a negative log roll (to determine the piriformis syndrome (where the piriformis muscle compresses the sciatic nerve), a normal Faber test (to determine pathology of the hip joint), and tenderness to palpation over the anterior hip, but not over the greater trochanter.  There was discomfort with hip flexion and not with resisted abduction.  The range of motion (ROM) was 90 degrees of flexion, 15 degrees of extension, 35 degrees of abduction, 40 degrees of internal rotation and 35 degrees of external rotation.  Motor strength was 5/5 in all major motor groups.  The CI was unable to run, stand for prolonged periods or road march due to hip pain, which also occurred when she lifted heavy objects.  For left hip chronic hip pain she took either Flexeril (cyclobenzaprine, a muscle relaxer) or Tylenol (acetaminophen, a pain reliever) with codeine (a narcotic) at night.  

At the VA Compensation and Pension (C&P) examination dated 6 April 2004, performed 1 month before separation, the CI reported pain, weakness, stiffness, fatigue, and lack of endurance, but no dislocation or recurrent subluxation.  On examination no overt deformity was noted.  There was tenderness to palpation throughout the inguinal ligament area which radiated posteriorly to the gluteal area.  The ROM measurements at the left hip were flexion 0-90 degrees, abduction 0-45 degrees, adduction 0-30 degrees, internal rotation 0-40 degrees, and external rotation 0-45 degrees; all motions except abduction were painful.  The chronic hip pain was diagnosed as chronic left hip strain.

The 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.

DOS 20040520
Left Hip (Thigh) ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
	VA C&P ~1 Mo. Pre-Sep
	
Flexion (125 Normal)	90	90	
Extension (20)	15		
External Rotation (45)	35	45	
Abduction (0-45)	35	45	
Adduction (45)		30	
Comment	Motor strength normal; discomfort with hip flexion	Painful motion	
§4.71a Rating	(PEB 20%)	10% (VA 20%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating using code 5099-5003 for chronic pain, left hip, rated as moderate/constant IAW USAPDA policy.  The VA assigned a 20% rating using code 5099-5003 for left hip strain.  However, in the absence of hip ankylosis (code 5250), thigh limitation of flexion to 20 degrees or less (code 5252), hip flail joint (code 5254) or femur impairment (code 5255) the Board was unable to find a route to a higher rating.  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 chronic pain, left hip condition.

BOARD FINDINGS:  In the matter of the chronic pain, 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.  

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 20140707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

SAMR-RB

XXXXXXXXXXXXXXXX

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 XXXXXXXXXXXXXXXXXXXX, AR20160011474 (PD201403417)

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