RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00277
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheeled Vehicle Mechanic, medically separated for right hip pain, with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20021003	VARD - 20030721 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain 	5099-5003	0%	Right Hip Strain	5252	10%	20030508	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Hip Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right hip during advanced individual training (AIT), approximately 3 years prior to referral for MEB.  At a 1 August 2001 physical medicine and rehabilitation (PM&R) evaluation, the CI complained of intermittent 6/10 right hip pain.  The right hip examination revealed no edema (excess tissue fluid swelling) or ecchymosis (bruising).  Right hip range of motion (ROM) was flexion of 120 (125 normal) and extension of 0 (20) degrees.  The Patrick test (assesses hip and sacroiliac joint pathology) was negative.  A right hip diagnostic imaging (MRI) study was normal.  At a 21 November 2001 orthopedic surgery encounter, the CI complained of right hip “popping” since AIT.  The right hip examination revealed palpable popping with flexion and extension.  Right hip ROM was full.  The assessment listed probable occult labral tear or other soft tissue impingement.  The examiner recommended intraarticular injection of local anesthetic (Xylocaine) as a workup for possible hip arthroscopy.  The CI declined surgical intervention.  In a 12 March 2002 acute care encounter, the CI complained of increasing right hip pain with no history of trauma.  The right hip examination revealed no edema, erythema (redness), ecchymosis, crepitus (grating sensation or sound), or tenderness.  Right hip active ROM was full.  In the 10 July 2002 NARSUM, 5 months before separation, the CI complained of right hip pain and popping since AIT with associated stiffness.  Pain was exacerbated by strenuous walking, marching, running, jumping, flutter kicks, and sit-ups.  There was no significant improvement with conservative management which included rest, stretching, heat/ice, activity modification, physical therapy (PT), and medication (nonsteroidal anti-inflammatories [NSAIDs], skeletal muscle relaxant).  The CI declined surgery.  The physical examination documented a normal gait.  There was mild tenderness to palpation over the right hip.  The lower extremity active ROM was full.  The distal extremities were neurovascularly intact.  The examiner recounted the findings of the normal X-rays and MRIs.  The diagnosis listed right hip pain.  In the 8 May 2003 compensation and pension (C&P) examination, 5 months after separation, the CI complained of occasional right hip pain.  “He has occasional popping sensation producing a severe to dull ache lasting about 10 minutes.  It shoots down his leg and slightly to the torso.”  Symptoms were precipitated by activity, running, bending, squatting, and heavy lifting.  The physical examination documented a normal posture and gait with no ambulatory aids.  The right hip examination revealed no tenderness.  There was popping with extension and flexion.  Right hip ROM was flexion of 100 (125) and extension of 30 (20) degrees.  Strength, sensation, pulses, and deep tendon reflexes (DTRs) were normal.  A right hip X-ray showed no bone or joint abnormalities.  The diagnosis listed right hip strain with mild functional loss due to pain and decreased ROM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing right hip pain, without specific history of trauma/injury, not using pain medications, full ROM, normal gait, normal neurovascular exam, normal X-rays and MRI, and rated for pain in accordance with PDA pain policy.  The VA assigned a 10% rating under the 5252 code (thigh, limitation of flexion of) based on the VA C&P examination 5 months after separation, citing right hip pain, severe to dull ache, no tenderness with palpation, popping heard with extension and flexion, ROM, normal X-ray, and mild functional loss due to pain and decreased ROM.  There was no compensable limitation of motion for consideration under 5251 (thigh, limitation of extension of) or 5252 (thigh, limitation of flexion of).  There was no evidence of disability for consideration under 5250 (hip, ankylosis of), 5253 (thigh impairment of abduction, adduction, rotation of), 5254 (hip, flail joint), or 5255 (femur fracture nonunion/malunion of).  Board members agreed a 10% rating was justified IAW §4.40 (functional loss) and §4.59 (painful motion).  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 right hip condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right hip condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 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	RATING	
Right Hip Pain 	5099-5003	10%	

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

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019820 (PD201500277)

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