RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03620
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Health Care Specialist, medically separated for “chronic right trochanteric bursitis,” with a disability rating of 10%.  

CI CONTENTION:  The CI asserts that due to her pain she is unable to work as a licensed vocational nurse and is therefore homeless.  She requests that all conditions be considered.  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 - 20090625	VARD - 20091217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Trochanteric Bursitis	5019	10%	Right Hip Condition	5252	NSC	STR	
Chronic Low Back Pain…	Not Unfitting	Thoracic Spine Condition (Also Claimed As Lower Back
Condition)	5237	NSC	STR	
Thoracic Spine Pain…	Not Unfitting					
Depression and Anxiety	Not Unfitting	Depression and Anxiety Disorder	9413	NSC	STR	
		Adjustment Disorder with Depression Mood	9440	NSC	STR	
Migraine Headaches	Not Unfitting	Migraines	8100	NSC	STR	
Hand Paresthesia Secondary to Mild Bilateral Carpal Tunnel Syndrome	Not Unfitting	Left Carpal Tunnel Syndrome	8715	NSC	STR	
		Right Carpal Tunnel Syndrome	8715	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Right Trochanteric Bursitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began during basic training in 2006.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded chronic right trochanteric bursitis for PEB adjudication.  The MEB NARSUM examination on 1 April 2009 (summary dated 29 April 2009), 6 months prior to separation, noted complaints of severe hip pain increased with activity that limited running, jumping, walking and interfered with sleep.  Bone scan from July 2008 showed non-specific right femoral head findings with a normal follow-up MRI (magnetic resonance imaging) later that month.  Physical examination showed tenderness with normal hip range of motion, with a DeLuca assessment that prolonged ambulation could produce a flare.  Provocative tests were negative.  Gait was normal and the CI could walk on heels and on toes.  Neurologic exam was normal including motor, sensory, and reflex testing.  There was no VA Compensation and Pension (C&P) evaluation conducted proximate to separation.  VA documents indicate that the CI failed to report to her VA examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5019 (bursitis), citing tenderness and pain with consideration of VASRD §4.10 and §4.40 (functional impairment and functional loss).  The VA adjudicated a not service connected finding using the 5252 code (thigh, limitation of flexion) based on the STR and citing lack of evidence of a “chronic” (permanent) condition.  The Board agreed that a 10% rating, but no higher, was justified for functional loss (based on §4.10, §4.40, §4.45) for the right hip condition.  There was no limitation of motion which attained a higher rating under the diagnostic codes for hip limitation of motion (5250 thru 5254), no fracture or malunion of the femur, or greater than slight hip impairment to support any higher rating under code 5255 (impairment of femur).  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 condition.  

Contended PEB Conditions:  Chronic Low Back Pain, Thoracic Spine Pain, Depression and Anxiety, Migraine Headaches, and Hand Paresthesia Secondary to Mild Bilateral Carpal Tunnel Syndrome Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic low back pain, thoracic spine pain, depression and anxiety, migraine headaches, and hand paresthesia secondary to mild bilateral carpal tunnel syndrome conditions, the Board unanimously recommends no change from the PEB determinations 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 20140728, 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 XXXXXXXXXXXXXXXXXXXX, AR20160014209 (PD201403620)

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