RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-04017
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20090126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Human Resources Specialist, medically separated for a left hip condition, rated at 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  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 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:

SERVICE PEB - 20081028	VARD - 20090218 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Tenosynovitis	5024	10%	Left Hip Strain	5252-5024	10%	20090218	
Insomnia	Not Unfitting	Insomnia	9410	NSC	20090218	
Bilateral Knee Pain	Not Unfitting 	Left Knee Strain	5260-5024	10%	20090218	
		Right Knee Strain	5260-5024	10%	20090218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Left Hip Condition.  The CI developed left hip pain after basic training ruck marching in February 2007.  X-rays of the hip and pelvis as well as a bone scan were normal.  Diagnosed as a thigh strain, she was referred to physical therapy (PT).  There were inconsistent notes in the service treatment record with regard to painful extension into her left leg.  Despite aggressive PT, her painful symptoms remained.  She was permanently profiled in August 2008 with a diagnosis of left hip pain and referred to a Medical Evaluation Board (MEB).  At the 27 August 2008 narrative summary (NARSUM) examination, 5 months pre-separation, the CI reported a 7/10 left hip pain that radiated down to her left knee and foot and was aggravated by prolonged walking, standing, sitting or any motion involving internal or external hip rotation.  The physical examination revealed left hip tenderness and a normal gait.  There was decreased and painful motion of the left hip as demonstrated by her inability to perform maneuvering tests.  Her diagnosis remained left hip pain due to left rectus femoris tendonopathy.  At the 18 February 2009 VA Compensation and Pension (C&P) examination a month after separation, the CI endorsed constant left hip pain that radiated to her back and left knee.  Her symptoms were aggravated with physical activity and relieved with medications.  She maintained the ability to function with medication during painful flare-ups.  Her examination revealed a normal gait and posture.  There was decreased and painful motion of the left hip.  Absent was any evidence of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement about the left hip.  The VA examiner noted, “… there is no diagnosis because there is no pathology to render a diagnosis” in reference to either hip.  The goniometric range of motion (ROM) evaluations in evidence the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Hip (Thigh) ROM
(Degrees)	MEB ~5 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Flexion (125 Normal)	65,62,59	100	
Extension (20)	8,9,8	30	
External Rotation (45)	-	40	
Abduction (0-45)	28,19,18	25	
Adduction (45)	-	25	
Comment	painful motion (seen by heel and toe walk)	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Although the service and VA titled the hip condition slightly different, they both rated 10% and utilized (in various combinations) similar codes of 5024 (tenosynovitis) and 5252-5024 (thigh, limitation of flexion-tenosynovitis), respectively.  ROM limits were not compensable, but Board members agreed that sufficient evidence of painful motion was present to justify the service’s 10% rating IAW VASRD §4.59.  Absent evidence of ankylosis, worsening limitation of motion, or abnormal boney involvement, all Board members agreed there were no available alternative joint or analogous coding options which are applicable and or advantageous to the CI’s current 10% rating.  There also was no evidence of a ratable neurologic impairment or documentation of incapacitating episodes in this case which would provide for additional or higher rating.  Therefore, Board members agreed that a rating higher than 10% was not justified.  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’s adjudication for the left hip condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the insomnia and bilateral knee pain conditions were not unfitting.  Neither condition was profiled or implicated in the commander’s performance and functional statement nor were they judged to fail retention standards.  Both conditions were reviewed and considered by the Board.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 either condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended insomnia and bilateral knee pain 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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 28 2016

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for, AR20160009455 (PD201404017)

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