RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-04130
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20041123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Basic Trainee, medically separated for “left hip pain 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 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 - 20040914	VARD - 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5255	0%	Residuals, Left Hip Fracture	5255	10%	20050628	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially tripped and sprained her left ankle in March 2004 while in basic training.  Over the course of the next few weeks, she developed left hip pain which was thought to be from a stress fracture.  A “small mild stress fracture” was shown on bone scan on 26 April 2004.  She was treated conservatively with duty restrictions, medications, physical therapy (PT), and partial weight bearing (crutches), but her pain persisted.  A repeat bone scan on 23 June 2004 showed little change in the left hip.  However, previously noted stress fractures of the left ankle and right foot were healing well.  An MRI on 13 July 2004 was suggestive of a left hip stress reaction.  She was determined to not meet retention standards and recommended for an MEB.  The MEB forwarded left hip pain for PEB adjudication.  
At the MEB examination (recorded on DD Forms 2807 and 2808) dated 6 August 2004, the CI was noted to have decreased range of motion (ROM) due to pain.  The MEB NARSUM examination on 13 August 2004 noted that the CI had persistent pain despite 15 weeks of treatment.  On examination, the ROM was reduced and painful.  At the VA Compensation and Pension (C&P) evaluation performed on 28 June 2005, 7 months after separation, the CI reported that she was seeking work as a receptionist.  She endorsed morning stiffness and an intermittent limp.  The ROM was reduced and painful.  The left hip was tender to palpation.  Her symptoms increased with repetition.  The ROM examinations in evidence which 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 ~3 Mo. Pre-Sep	VA C&P ~7 Mo. Post-Sep	
Flexion (125 Normal)	100	100	
Extension (20)	10	---	
External Rotation (45)	45	35	
Abduction (0-45)	---	40	
Adduction (45)	---	#	
Comment	Painful and limited motion	Painful and limited motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip pain at 0%, coded 5255 (impairment of the femur).  The VA rated the residuals of left hip fracture at 10%, also coded 5255.  The CI showed limited and painful motion on both examinations as well as persistent findings of a repeat bone scan and MRI.  The gait was not recorded, but she endorsed an occasional limp.  This supports a 10% rating under code 5255 for slight hip disability from malunion.  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 5255.  

BOARD FINDINGS:  In the matter of the left hip pain condition, the Board unanimously recommends a disability rating of 10%, coded 5255 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Hip Pain	5255	10%	

The following documentary evidence was considered:

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

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 AR20160013690 (PD201404130)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA