RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00192
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4, Petroleum Supply Specialist, medically separated for left hip pain, with a disability rating of 20%.

CI CONTENTION:  The applicant requests that his disability ratings be reassessed for fairness and accuracy.  His complete submission, with attachments, 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 20060713	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Hip…	5099-5003	20%	Chronic Left Hip Pain	5299-5254	NSC	20070102	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	10%	STR	
Other MEB/PEB Conditions x 0	Other x 1	
RATING:  20%	RATING:  10%	
	*Derived from VA Rating Decision (VARD) dated 20070929 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Left Hip Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip pain (with no associated trauma) began roughly in August 2005 while deployed to Iraq.  During the course of evaluation he was noted to have lymphadenopathy (palpable enlargement of the lymph node) in his left groin, which led to his redeployment back to the U.S. for further evaluation.  Biopsy performed 4 October 2005 revealed a benign cyst, and watchful waiting was the chosen course of action.  The CI, however, was left with chronic left hip and groin pain.  Radiographic studies performed in December 2005 were initially suspicions for a stress fracture with MRI in 2006 being negative.  The CI was taking medication for sleep and narcotic and non-narcotic pain medication.  Despite treatment, the left hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty, so he was referred for MEB.  There was no surgical indication other than the previously mentioned biopsy.

The MEB NARSUM dated 15 March 2006 (5 months prior to separation), noted no tenderness, though there was pain with internal and external rotation of the hip.  The examiner indicated the CI could not perform basic soldiering duties, but that it was unclear what the etiology (cause) of the condition was and that “the workup has been normal.”  At the MEB examination (recorded on DD Form 2807 and 2808) dated 17 March 2006, the CI reported his lymphadenopathy and biopsies, but indicated no impaired use of legs, no swollen or painful joints, and no joint deformity.  He also denied inability to stand or perform certain motions.  Physical examination reported bilateral inguinal nodes and 4/5 motor testing of hip flexors and extensors.

At the VA Compensation and Pension (C&P) examination on 2 January 2007 (5 months after separation), the CI reported the pain was in his left groin, not his left hip.  Pain was reported as constant, 7/10 (with 10 being the highest), which flared at night or with any physical activity or walking more than 15 feet.  It did not interfere with attending school and the CI was not using any mechanical aid.  Physical examination showed a normal non-tender groin examination.  There was no pain with motion of the hip, and “no evidence of weakness, lack of endurance, fatigue, or incoordination with repetition of three.”  Gait was reported as “steady and smooth.”  Radiographs showed surgical clips and sutures near the left hip area from the previous surgery.  Remote VA records (2014) documented increased left hip disability and rating of 20% effective in 2014.

The range-of-motion (ROM) evaluations 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 NARSUM
~5 Mo. Pre-Sep	VA C&P
~5 Mo. Post-Sep	
Flexion (125 Normal)	120	125	
Extension (20)	10	30	
External Rotation (45)	14	60	
Abduction (0-45)	40	45	
Adduction (45)	20	25	
Comment	Painful motion & antalgic gait post-test	Normal gait; no pain; negative DeLuca	
§4.71a Rating	10%*	0%	
*IAW 4.59 painful motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 20% (coded 5099-5003, Analogous to arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA found the left hip condition not service-connected (NSC), indicating that “pain in and of itself is not considered a disability for the purpose of VA compensation.”  

There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of motion (diagnostic codes 5251, 5252, or 5253), and neither service nor VA evidence supported malunion of the femur (VASRD code 5255).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59 Painful motion, §4.40 Functional loss and §4.45 Joints) as reported on the NARSUM examination (on internal and external rotation of the hip).  The rating for neuralgia of the ilio-inguinal nerve (code 8730) would yield only 10% for severe neuralgia, with no higher alternative possible.  No route to a rating of 20% under VASRD guidelines could be found, nor did the evidence support a rating higher than the 20% adjudicated by the PEB for this 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 chronic left hip pain condition.

Contended Migraine Headaches.  The Board’s main charge is to assess the fairness of the PEB’s determination that migraine headaches were not unfitting.  The migraine headaches were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  This condition was reviewed and considered by the Board.  There was no performance based evidence from the record that migraines significantly interfered with satisfactory duty performance.  After due deliberation 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 the contended migraine headaches, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left hip condition and IAW DoDI 6040.44, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, 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 20150309, w/atchs
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 XXXXXXXXXXXXXXXXXXXXX AR20160014233 (PD201500192)

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