RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00427
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Multi-channel Transmission Operator/Maintainer, medically separated for “chronic right 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 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 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 - 20051031	VARD - 20061023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5019	0%	Chronic Bursitis, Status Post Trauma, Right Hip	5019	0%	STR	
Hematuria	Not Unfitting 	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in November 2002 after falling down stairs.  Initial records at the time of injury revealed sick call screening slips that indicated a right hip bursitis condition although the CI self-reported the finding of a right femoral neck (hip) fracture from the fall.  A clinic note dated 26 January 2004 reported that all previous medical records were misplaced.  Surgical intervention was not performed.  Radiographic studies of the right hip that were remote (7 June 2004 and 17 May 2005) to the original injury were reported as normal without evidence of a prior fracture.  Despite medications, physical therapy (PT), and local injections, the CI’s hip pain could not be adequately rehabilitated to allow unrestricted duty.  The MEB forwarded “trochanteric bursitis” for PEB adjudication.  

At the MEB NARSUM examination on 1 September 2005, 3 months prior to separation, the CI endorsed continued non-radiating right hip pain aggravated by any exertion involving the right leg.  He reported the inability to perform sit-ups, push-ups, running, or prolonged walking.  His physical examination revealed near-normal range of motion (ROM) noting decreased hip adduction of 15 degrees (normal 45).  Painful motion and hip tenderness was present.  His documented diagnosis remained as “right hip pain, probably secondary to trochanteric (hip) bursitis”.  

The CI failed to present for a scheduled VA Compensation and Pension examination.  An orthopedic clinical encounter on 20 September 2005, 3 weeks after the NARSUM, noted very similar ROM with improved adduction to 25 degrees (normal 45).  All directional movements were without pain.    

The Board directed attention to a rating recommendation based on the above evidence.   Both the PEB and VA coded the right hip condition as 5019 (bursitis) rated at 0%, citing the absence of motion loss and painful motion, respectively.  All Board members first agreed that the CI apparently had marked symptom improvement during the 3-week period between the NARSUM and orthopedic examinations as evidenced by improved and non-painful ROM.  Members carefully reviewed the limited adduction to determine if there was support for a ROM impairment code of 5253 (thigh impairment) as it related to the ability to cross ones’ legs.  After extensive discussion, all members agreed that the minimum angle of hip adduction necessary to accomplish crossing of the legs (as to have one foot over the other) would be at the 25 degree point.  Therefore, in the absence of other ROM limitations, hip ankylosis, painful motion, persistent fractures without nonunion or malunion and or the presence of hip disability equivalent to at least “slight,” there is no route to an impairment rating higher than the PEB’s current 0% under any applicable code and no coexistent pathology which would merit additional rating for the hip condition under any other separate 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’s adjudication for the right hip condition.  

Contended PEB Condition:  Hematuria.  The Board’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 or implicated in the commander’s statement or judged to fail retention standards.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the hematuria condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hematuria condition, the Board unanimously recommends no change from the PEB’s 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, with 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

07 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019846 (PD201500427)

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