RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04117
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Military Paralegal, medically separated for “chronic bilateral hip pain…” rated 0%.

CI CONTENTION:  The CI 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 – 20050922	VARD - YYYYMMDD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain…Rated for Pain	5099-5003	0%	Right Greater Trochanter Bursitis	5019	0%	20070413	
			Left Greater Trochanter Bursitis	5019	0%		
Dyslipidemia	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Chronic Bilateral Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition insidiously began in late 2001.  Radiographic imaging studies of both hips were normal.  Conservative treatment to include local steroid injections did not result in improvement sufficient to allow for unrestricted duty.  The MEB forwarded “chronic bilateral greater trochanteric bursitis” for PEB adjudication.

At the MEB NARSUM physical examination (PE) performed on 30 August 2005, 3 months prior to separation, the CI’s chief complaint was “severe hip pain, left greater than right.”  Her hip and lower extremity focused PE was completely normal excepting bilateral hip tenderness; left greater than right.  Painful motion was not present as seen by “negative” log roll testing of both lower extremities.  The VA Compensation and Pension (C&P) examination was performed 17 months remote from separation and past the time frame for consideration as probative evidence.  Therefore, the STR and MEB encounters were afforded significantly higher probative value in determining an impairment rating.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB bundled the bilateral hip condition and assigned a 0% rating under an analogous 5003 code (degenerative arthritis), citing painful motion.  The VA assigned separate ratings of 0% utilizing VASRD codes of 5019 (bursitis) based upon the 17 month remote examination.  The Board’s initial charge in this case was directed at determining if the PEB’s approach of combining the bilateral hip condition as a single rating was justified in lieu of separate ratings.  The Board must apply separate codes and ratings in its recommendations if compensable ratings for each extremity condition are achieved IAW VASRD §4.71a.  If the Board judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each ‘unbundled’ condition is reasonably justified as unfitting in and of itself.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), all Board members agreed that the sole clinical finding of hip tenderness coupled with the absence of ankylosis, ROM deficit, or boney abnormalities would not rise to a positive impairment rating when considered either separately or bundled.  Therefore, the Board does not see a path to a higher rating recommendation for the bilateral hip condition, regardless if each hip would be found separately unfitting.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that dyslipidemia was not an unfitting condition.  All Board members agreed that   dyslipidemia is a laboratory finding and therefore, is not a ratable condition. 

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended dyslipidemia diagnosis, the Board unanimously recommends no change from the PEB determination 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 
, AR20160018244 (PD201404117)

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