RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04237
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Patriot Missile Operator/Maintainer, medically separated for “left hip pain" with a disability rating of 10%.  

CI CONTENTION:  “Please 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 - 20090220	VARD - 20080821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5022	10%	Left Hip Strain	5099-5014	0%	20080527	
Left Knee Pain	Not Unfitting	Left Knee Condition	5299-5260	NSC		
Lumbago	Not Unfitting	No VA Placement	
Neck Pain	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip condition began in October 2006 when he suffered an injury during physical training.  A bone scan in November 2006 showed a stress reaction without fracture, and magnetic resonance imaging showed no abnormalities.  Orthopedics was consulted and no surgery or intervention was recommended.  The MEB forwarded “hip joint pain” for PEB adjudication.  

At the MEB examination dated 10 December 2007, 2 months prior to separation, the CI reported chronic dull pain with intermittent sharp pain associated with movement.  Any activity greater than slow walking caused the sharp severe pain.  Physical examination showed tenderness with motion of the left hip.  There was no laxity, crepitus or muscle atrophy noted.  Lower extremity strength, sensation, and reflexes were normal.  Physical therapy measured range of motion (ROM) for the MEB on 2 January 2008 and hip flexion was 110 degrees (normal 125 degrees), extension was 0 degrees (normal 20 degrees), abduction was 30 degrees (normal 45 degrees).  The therapist indicated the CI was able to toe out greater than 15 degrees (normal), but was not able to cross his legs (adduction) secondary to pain.  

At the VA Compensation and Pension (C&P) examination in May 2008, performed 4 months after separation, the CI reported pain in the front left thigh after he stands or walks about 5 minutes. Leg motion and jumping also cause immediate pain.  Pain is relieved immediately with sitting or lying down.  He used no medication or any other treatment other than repositioning.  Physical examination showed a normal gait and station and the CI was noted to move quickly and easily without distress throughout the exam.  There was tenderness and pain with hip motion, without effusion, redness, or swelling.  Hip flexion and abduction ROM was full and was without pain or additional limitation of motion with repetition.  The neurological examination was normal, with normal LE musculature and reflexes noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5022 code (Periostitis), citing left hip pain due to stress reaction.  The VA assigned a 0% rating using the 5014 code (Osteomalacia) based on the VA C&P examination 4 months after separation, citing a non-compensable evaluation.  

There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB or 5251 (limited thigh extension), or coded as 5253 (thigh impairment) for “limitation of adduction, cannot cross legs.”  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of thigh flexion or extension, thigh impairment (5251, 5252).  There was no evidence of hip ankyloses, flail hip joint, or femur impairment (5250, 5254, 5255) for a rating under the respective codes. There was therefore no route to a rating higher than the 10% adjudicated by the PEB under any applicable VASRD §4.71a code.  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 hip condition.  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 left hip condition.  

Contended PEB Conditions: Left Knee Pain, Lumbago, and Neck Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The left knee, lumbago and neck conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  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 left knee pain, lumbago and neck pain, and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left hip condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee pain, lumbago and neck 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 20141029, 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 
XXXXXXXXXXXXXXXXXX, AR20160018295 (PD201404237)

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