RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04112
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Healthcare Specialist, medically separated for “bursitis, right greater trochanteric,” with a disability rating of 20%.

CI CONTENTION:  The CI requests consideration of 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:  

IPEB - Dated 20090223	VARD – No Exam	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bursitis, Right Greater Trochanteric (Residual Femoral Stress Fracture)	5019-5251	10%	No VA Exam	
Left Shoulder Calcific Tendonitis	Not Unfitting		
Acute Stress Disorder	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Greater Trochanteric Bursitis as a Residual of a Femoral Neck Stress Fracture.  The service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) indicated the CI complained of right thigh pain and stiffness while in basic training in June 2008.  A bone scan in June 2008 revealed increased tracer activity about the lower extremity joints, most consistent with stress change, while magnetic resonance imaging (MRI) in July 2008 demonstrated a right femoral neck stress fracture, compressive side.  The CI was treated with crutches, nonsteroidal anti-inflammatory drugs (NSAIDs) and profiles.  Shortly afterward she developed a right greater trochanter bursitis, which was treated with a cortisone/anesthetic injection that resulted in relief of her pain and discomfort.  Two months later she reported occasional twinges of pain.  X-rays showed normal bony alignment, no soft tissue edema, no fractures, and no sclerosis.  The orthopedic surgeon’s assessment was a clinically healed right side compressive side femoral neck stress fracture.  Physical therapy was to continue to get the CI to running again.  An MRI of the right hip in January 2009, ordered for persistent right hip pain, demonstrated interval resolution of the prior right hip stress fracture and mild bilateral greater trochanteric bursitis.  At the NARSUM examination dated 27 January 2009, approximately 1 month prior to separation, the CI noted her pain was present 100% of the time during the day while awake with intensity of 4-5/10 which was not activity related.  On examination of the right hip there was moderate to severe tenderness over the greater trochanter and within the right groin with mild to moderate discomfort to the posterior aspect of the hip.  There was no obvious quadriceps or hamstring atrophy.  She had a positive Patrick’s test (to determine hip pathology), was able to cross her legs without difficulty and demonstrated out-toeing at approximately 40 degrees.  At the MEB examination dated 14 January 2009, 2 months prior to separation, the CI checked off swollen or painful joint.  The examiner noted right hip pain with flexion 95 degrees, extension 5 degrees, and abduction 30 degrees.  

There was no VA Compensation and Pension (C&P) examination in the record proximate to separation.   However, at a VA clinic visit in October 2009, 7 months after separation, the CI’s hip flexion was 120 degrees with pain on internal rotation and tender trochanteric bursae bilaterally.  ROM testing in November 2009 revealed flexion of 110 degrees and abduction 40 degrees.    Physical therapy was instituted in December 2009 and continued thereafter intermittently.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5019-5251 code (bursitis-thigh, limitation of extension), citing bursitis, described as right greater trochanteric bursitis.  The VA assigned a 10% rating, although under an analogous 5019-5251 code based on a VA treatment records from March 2009 to February 2010, from separation to 9 months after separation, citing greater trochanteric bursitis, right hip.  Board members discussed whether code 5299-5255 (femur impairment-malunion with moderate hip disability) was reasonable; however, since the stress fracture was no longer the primary issue, its use is unlikely.  Therefore, in the absence of hip ankylosis (code 5250), thigh limitation of flexion (code 5252), thigh impairment (code 5253), or hip flail joint (5254), a higher rating cannot be achieved.  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 greater trochanteric bursitis condition

Contended PEB Conditions:  Left Shoulder Tendonitis and an Acute Stress Disorder.  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 greater trochanteric bursitis as a residual of a femoral neck stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left shoulder tendonitis and acute stress disorder 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						

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 
AR20160018240 (PD201404112)

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