RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03864
BRANCH OF SERVICE: MARINE CORPS                                                  SEPARATION DATE:  20080531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Supply Administrator, medically separated for “left chronic trochanteric bursitis” with a disability rating of 0%.

CI CONTENTION:  The CI requests the Board 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 - 20080326	VARD - 20080715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Chronic Trochanteric Bursitis	5019	0%	Left Hip Bursitis	5019	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Hip Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left hip pain began in boot camp, approximately 18 months prior to referral for MEB.  At an 18 October 2006 encounter, the CI complained of left anterior hip pain since boot camp in July 2006.  Inciting factors were routine physical training, runs, and hikes.  Symptoms were characterized as deep, sharp, and stabbing pain at the greater trochanter (proximal lateral femur bony prominence) with intermittent shooting pain down the anterior thigh.  The left hip examination revealed no tenderness and a normal appearance.  Active range of motion (ROM) was normal.  Pain was elicited with flexion, abduction, and external rotation.  The examiner recounted the unremarkable findings of the hip X-ray and bone scan.  
The assessment listed left hip strain.  At a 7 October 2007 follow-up, the CI complained of 16 months of left lateral hip pain over the greater trochanter which radiated to the anterior hip and groin.  The left hip examination revealed greater trochanter tenderness with no deformity or evidence of infection.  Active ROM was flexion of 80 (125 normal), extension of 20 (20 normal), external rotation of 30 (45 normal), abduction of 30 (45 normal), and adduction of 40 (45 normal) degrees.  Pain was elicited with abduction.  The hip roll test (assesses for hip joint pathology) was negative.  Strength, sensation, and pulses were normal.  The assessment listed left greater trochanteric bursitis (inflammation of the bursa [fluid-filled sac near joint] at lateral hip).  In the 16 January 2008 NARSUM, 5 months before separation, the CI complained that his left lateral hip pain had gradually increased since boot camp.  During his deployment to Ramadi Iraq, his hip pain became increasingly problematic.  In-theater X-rays were normal.  A left hip MRI performed in Kuwait, to rule out a femoral neck stress fracture, was normal.  The CI did not experience significant improvement with conservative management which included activity modification, extensive physical therapy (PT), corticosteroid injections, and nonsteroidal anti-inflammatory medicines.  The physical examination documented “He walks without a Trendelenburg gait [gait dysfunction from weak hip abductors] and is able to support his pelvis in a single stance on the left, although, he does have some pain doing so.”  The left hip examination revealed tenderness along the greater trochanter and slightly proximal to it.  Active ROM was full and slight pain was elicited with abduction.  Strength, sensation, and pulses were normal.  The examiner recounted the findings of the X-rays and MRI.  The assessment listed chronic left greater trochanteric bursitis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5019 code (bursitis) citing left chronic trochanteric bursitis.  The VA assigned a 0% rating under the 5019 code (bursitis) based on Service Medical/Treatment Records and documenting that the CI failed to report for the VA compensation and pension (C&P) examination.  The VA cited left hip bursitis due to injury and 18 months of chronic left hip pain.  The 5019 code is rated on limitation of motion of affected parts as degenerative arthritis (5003).  There was no compensable limitation of motion for consideration under 5251 (thigh, limitation of extension of) or 5252 (thigh, limitation of flexion of).  There was no evidence of disability for consideration under 5250 (hip, ankylosis of), 5253 (thigh impairment of abduction, adduction, rotation of), 5254 (hip, flail joint), or 5255 (femur fracture nonunion/malunion of).  Board members agreed a 10% rating was justified IAW §4.40 (functional loss) and §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left hip condition, coded 5019.  

BOARD FINDINGS:  In the matter of the left hip condition, 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Chronic Trochanteric Bursitis	5019	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXX   
	(c) PDBR ltr dtd 22 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 21 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 16 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 21 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 4 Oct 16 ICO  XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     b. Entitlement to disability severance pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.  

     c. Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by assignment to the Permanent Disability Retired List with a final disability rating of 30 percent (increased from 10 percent).  

     c. Entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.   

     e. An increase in disability rating from 30 percent to 60 percent for the period on the Temporary Disability Retired List followed by a final disability rating of 20 percent with entitlement to disability severance pay.

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     f. Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     g. Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.