RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03790
BRANCH OF SERVICE:  Army	BOARD DATE:  20150623
SEPARATION DATE:  20070109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Health Care Specialist) medically separated for chronic right hip pain.  The hip condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right hip pain S/P open reduction and internal fixation for femoral neck stress fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right hip pain, S/P operative fixation of femoral neck stress fracture” as unfitting, rated 20%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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:

IPEB – Dated 20061215	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain…..	5099-5003	20%	Status Post Right Hip Fracture…	5299-5003	10%	20070321	
Other x 0 (Not In Scope)	Other x 2 (equals SC, NSC & deferred)	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070629 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Hip Pain Condition.  The record shows that the CI initially had a stress fracture of the right heel and then developed right hip pain which failed to resolve with duty restrictions.  A bone scan on 1 August 2006 was consistent with an early right hip (femoral neck) stress fracture as well as a healing left calcaneal (heel bone) stress fracture.  The former was confirmed on a magnetic resonance imaging on 1 August 2006.  He subsequently underwent open reduction and internal fixation of the right femoral neck (surgery to pin the fracture together) on 14 August 2006, followed by rehabilitation in physical therapy.  The narrative summary was dated 17 November 2006, 3 months after surgery and 2 months prior to separation.  The CI reported constant hip pain which he thought would preclude further military service.  The scar was noted to be well healed, but tender to touch.  X-rays showed a stable repair.  The range-of-motion (ROM) was reduced in flexion and external rotation; extension and internal rotation were not recorded.  Recovery was anticipated though.  The CI was seen in physical medicine on 30 January 2007, 3 weeks after separation, and reported continued pain and difficulty with stairs.  He ambulated independently, had normal motor function, and was able to get out of a chair easily.  X-rays showed good healing.  Continued rehabilitation was recommended.  In orthopedics on 15 February 2007, the ROM exceeded VA normal values.  He was noted to be tender at the site of the surgery.  Possible irritation from the screws (placed at surgery) versus bursitis was considered.  A steroid injection was performed and the CI advised to continue rehabilitation.  At the VA Compensation and Pension examination performed on 21 March 2007, 2 months after separation, the CI reported that he was getting steroid injections into his hip, but denied incapacitation.  His posture and gait were normal.  The ROM was full and exceeded VA normal values in some measurements, but painful at the end of motion and with repetition.  The scar was well healed and X-rays showed a healed fracture.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip at 20%, coded 5099-5003 (analogous to degenerative arthritis), using the USAPDA pain policy.  The VA rated the condition at 10%, coded 5299-5252 (analogous to limitation of flexion of the thigh) noting the increase in pain with repetition.  The Board considered the codes available for the hip and found no route to a rating higher than the 10% adjudicated by the VA.  However, it does not recommend a combined rating lower than what was adjudicated by the PEB.  After due deliberation 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 chronic right hip pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right hip pain was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic right hip pain 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.

RECOMMENDATION:  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 20140819, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB	0 6 JUL 2016

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, AR20160003075  (PD201403790)

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