RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00218
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Chemical Operations Specialist, medically separated for “chronic 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 panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical conditions at the time of separation.  The panel 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 panel 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 - 20090327	VARD - 20091007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain	5099-5003	10%	Left Hip Impingement	5252-5019	10%	20090925	
Major Depression	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic 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 January 2006 during a ruck march, and worsened after a fall during combatives training in July 2006.  Magnetic resonance imaging in July 2006 documented acetabular impingement.  

Ranges of motion (ROM) obtained 14 June 2007, 8 months prior to separation, showed flexion of 115 degrees (normal 125) with painful motion.  At the 18 September 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported constant pain that radiated to the thigh which was aggravated by standing, movement or pressure on the hip.  He reported an inability to run or walk more than one quarter to one half of a mile, and that he fell twice due to instability.  The examiner documented the ROMs from June 2007.  A 27 September 2007 orthopedic addendum documented a physical examination that showed tenderness, evidence of impingement and hip flexion to 130 degrees.  

At the 25 September 2009 VA Compensation and Pension (C&P) examination, 19 months after separation, the CI reported a constant ache in the groin that worsened after increased activity or prolonged standing; and occasional use of a cane.  He denied locking, clicking, or popping.  The physical examination showed flexion to 120 degrees (bilaterally), and no evidence of painful motion or tenderness, and no pain or further reduction in ROM after repetition.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left hip condition, analogously coded 5099-5003 (degenerative arthritis), citing a rating for pain with no significant limitation of motion or instability.  The VA also assigned a 10% rating, analogously coded 5252-5019 (thigh, limitation of flexion; bursitis), citing painful motion.  

The panel considered the evidence for a higher rating.  Application of VASRD §4.59 (painful motion), §4.40 (functional loss), and §4.45 (the joints) was supported by documentation (painful motion and mechanical limitations of the hip) for a 10% rating coded as 5252-5019.  There was no evidence of ankylosis (5250), or flexion limited to 30 degrees (5252) in support of a higher rating.  There was no evidence of limitations in abduction (motion lost beyond 10 degrees), or adduction (inability to cross legs), in support of a higher rating under 5253.  There was no documentation of limited rotation (cannot toe out more than 10 degrees) in support of a higher rating under 5253.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left hip pain condition.  

Contended PEB Condition:  Major Depression.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the major depression and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic left hip pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended major depression condition, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160108, w/attachments
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 XXXXXXXXXXXXXXXXXXXXX, AR20170003449 (PD201500218)

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