RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00560
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Imagery Analysis Journeyman, medically separated for “bilateral hip pain” with a disability rating of 10%.

CI CONTENTION:  “Additional conditions were not included in the assessment”  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 - 20081008	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain…	5003	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  The Board noted that PEBs often combine multiple conditions under a single rating when those conditions considered individually are not separately unfitting and would not cause the member to be referred into the Disability Evaluation System (DES) or be found unfit because of physical disability (DoDI 1332.38, paragraph E3.P3.4.4.; “Overall Effect”).  This approach by the PEB reflects its judgment that the constellation of conditions was unfitting, not a judgment that each condition was independently unfitting.  When combining conditions in this manner, the PEBs concluded that there was no need for separate fitness adjudications.  When considering a separate rating for each condition, the Board first must satisfy the requirement that each unbundled condition was unfitting in and of itself based on a preponderance of evidence.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in 2006 without specific injury or trauma.  X-rays July 2006 showed tears of the anterior labrum bilaterally; slightly more prominent on the left. Pain was so great she was unable to run and complete fitness test requirements.  Orthopedics performs left hip arthroscopy and debridement in September 2007 and right hip arthroscopy and debridement in February 2008.  Her symptoms did not improve at all and reportedly worsened.  Orthopedics informed the CI she may never run again without significant pain.  Medications, physical therapy and surgery did not improve her clinical symptoms. The MEB forwarded “bilateral hip labrum tears” for PEB adjudication.  

The MEB NARSUM examination on 2 June 2008, 6 months after separation, noted complaints of continued hip pain.  Physical examination showed right hip pain with ER (external pain?) and left hip pain with IR (internal pain?)  Neurological examination showed intact sensation, with normal motor strength.  Although she had a poor prognosis of being able to run without pain, her condition did not impede her ability to perform her duties.  There was no C&P examination since the CI did not file a VA claim.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 10%, coded 5003 (analogous to arthritis, degenerative).   The Board also noted that “bundling,” the combining of two or more major joints (in this case hips), is permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  Under code 5003, when the limitation of motion of the specific joint or joints involved is non-compensable under the appropriate diagnostic codes, a rating of 10% is applied for each such major joint or group of minor joints affected by limitation of motion.  Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.  

In this case, the evidence of the service treatment record indicated both hips were equally symptomatic and together were considered unfitting.  The symptoms and examination findings were essentially the same in both hips.  Examinations did not document the range of motion (ROM) and therefore there is no compensable ROM.  Board members noted that the MEB NARSUM examination supported a 10% for each hip individually.  X-rays and MRI documented bilateral labral hip tears and the MEB NARSUM examination revealed painful motion of each hip.   According to IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Although corrective surgery had been performed, there was persisting pain in both the right and left hip that interfered with work and were individually unfitting. There was not sufficient evidence of a significantly disabling hip condition to justify a rating greater than 10%.  The Board unanimously agreed that; IAW VASRD §4.40, §4.45, §4.59, and §4.71a, a disability separation rating of 10% was warranted for the right and the left hip condition individually.   

BOARD FINDINGS:  In the matter of the bilateral hip pain condition, the Board recommends that each joint be separately adjudicated as follows:  an unfitting right hip condition coded 5003 and rated 10%, and an unfitting left hip pain condition, coded 5003 and rated 10%, both 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	PERMANENT RATING	
Right Hip Pain	5003	10%	
Left Hip Pain	5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

PDBR PD-2015-00560

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to XXXXXXXXXXXXXXXXXXXXX, be corrected to show that the diagnosis in her finding of unfitness was Right Hip Pain, VASRD code 5003, rated at 10%; and Left Hip Pain, VASRD code 5003, rated at 10% with a combined disability rating of 20%.

SAF/MR

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00560.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings