RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03521
BRANCH OF SERVICE:  MARINE CORPS		SEPARATION DATE:  20011130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Aircraft Communications/Navigation Electronic/ Weapon Systems Technician-Trainee, medically separated for a “coxa saltans, right hip condition with a disability rating of 10%.  

CI CONTENTION:  The CI claims she was rated higher by the VA for her right hip condition.  Her 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 - 20011005	VARD - 20011130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coxa Saltans, Right Hip	5024-5003	10%	Coxa Saltans, Right Hip	5019	
10%
	20011023	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Hip Coxa Saltans (Snapping Hip).  According to the service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) dated 19 June 2001 indicated the CI’s right hip condition began approximately 13 months earlier when she complained of right hip pain that started during a run when she was in boot camp.  However, in October 1999 the diagnosis of right trochanteric bursitis was made and physical therapy was instituted, while in April 2000 the CI reported the pain persisted since the Crucible (a major exercise prior to the end of training).  Symptoms resolved but flared again in June 2000.  Pain was present on the lateral aspect of the right hip when the CI walked in the morning and was notable when she ran, although by August 2000 she was running two miles slowly three times a week.  Various measurements indicated her left leg was shorter than the right by 1-2 cm.  In October 2000 the CI was noted to have an antalgic gain and tenderness to palpation of the right lateral hip.  Physical therapy including iliotibial band (ITB) stretching, nonsteroidal anti-inflammatory drugs (NSAIDs) (Aleve (naproxen) and Motrin (ibuprofen), Tylenol (acetaminophen, a pain reliever), and a cortisone injection were unsuccessful in relieving the pain.  In May 2001 she reported feeling a pop on the lateral aspect of her hip when walking and was able to run about a block, but had to fall back.  She had a second steroid injection on 14 May 2001 and her NSAID was changed to oxaprozin.  She subsequently reported the injection actually made her pain dramatically worse and she complained of occasional paresthesia-like symptoms in her leg, but a neurologic examination was unremarkable.  X-rays of the right hip dated 18 May 2001 were also unremarkable as was a bone scan dated 9 June 2001.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 19 June 2001, 5 months prior to separation, the CI reported  “right hip ITB/snapping.”  The examiner noted tenderness to palpation at the right greater trochanter region and a full ROM.  At the NARSUM examination dated 19 June 2001 there was a full range of motion (ROM) of the right hip with mild discomfort over the lateral aspect of the hip near the gluteal insertion on the greater trochanter at the extreme of external rotation, which was full.  She was tender to palpation over the greater trochanter.  The Ober test was positive for a tight ITB, but no palpable snap was elicited.  The NARSUM examiner’s diagnosis was coxa saltans with ITB snapping syndrome.  As a result she was unable to walk greater than two blocks or run or jump without pain on the lateral aspect of her right hip.  Since she failed to improve, it was recommended she undergo a surgical procedure consisting of Z-lengthening of the ITB and a greater trochanteric bursectomy; however, she did not desire surgical intervention.  

At the 23 October 2001 VA Compensation and Pension (C&P) General examination, 1 month before separation, the CI reported popping in her hip and chronic pain with any strenuous exercise.  On examination she flexed the right hip 0 to 125 degrees and extended it to 30 degrees without difficulty.  She was able to abduct to 45 degrees but had pain around the greater trochanter at 25 degrees.  External and internal rotation of 60 degrees and 40 degrees respectively were present without any pain; however, the CI had slight tenderness over the greater trochanter area with abduction.  Her gait was normal and neurologic examination was unremarkable.  The CI had a partial resection of the ITB and a bursectomy on 6 February 2002, 3 months post-separation, but had continued pain postoperatively and used a cane.  A remote VA examination was performed in June 2006, almost 56 months after separation, with little or no probative value, revealed right hip flexion with the knee straight to be 90 degrees and extension 15 degrees with pain; and with the knee bent flexion was 120 degrees. 

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5024-5003 (tenosynovitis-degenerative arthritis) for coxa saltans, right hip.  The VA assigned a 10% rating using code 5019 (bursitis) for coxa saltans, right hip.  The Board members discussed whether analogous code 5399-5314 (Group XIV) at 10% for a moderate disability is applicable since it addresses the iliotibial band, albeit in the absence of a muscle injury, and the 10% rating does not afford any additional benefit to the CI.  However, with normal ROMs prior to separation, members did not feel in the absence of credible medical evidence that the CI’s condition rose to a moderately severe level with a rating of 30%; however, the Board members did note that surgery was recommended  prior to separation, and the CI did, in fact, have surgery 3 months after separation.  Nevertheless, in the absence of hip ankylosis (code 5250), thigh limitation of extension and flexion (codes 5251 and 5252), thigh impairment (code 5253), a hip flail joint (code 5254) or a femur impairment (code 5255), there was no route to a higher rating at the time of separation or 1 month thereafter based on the VA ROM measurements.  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 right hip coxa saltans condition.  

BOARD FINDINGS:  In the matter of the right hip coxa saltans 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 20140710, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 8 Aug 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  	 XXXXXXXXXXXXXXXXXXXX
	     				  		 Assistant General Counsel
						 	 (Manpower & Reserve Affairs)