RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00576
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20030305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-3, Military Police, medically separated for “chronic right hip pain,” with a disability rating of 10%.  

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  She was not evaluated for a back condition.  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:  

SERICE PEB - 20021223	VARD - 20030610  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	10%	Residuals S/P Hip Fracture	5252	10%	20030429	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Hip Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured her right hip in March 2002 in a fall on the obstacle course in basic training.  Right hip X-rays showed a possible subacute avulsion (forcible detachment of a bodily structure) fracture of the superior acetabular lip versus an accessory ossification center (bone formation site).  A whole body diagnostic imaging (bone scan) study showed no abnormal uptake to suggest a right hip fracture.  The 2 December 2002 Report of Medical Examination for the MEB (DD Form 2808) right hip examination revealed anterior and lateral (greater trochanter [proximal lateral femur bony prominence]) tenderness.  Pain-limited right hip range of motion (ROM) was flexion of 90 (125 normal) and abduction of 45 (45) degrees.  The 2 December 2002 NARSUM, 3 months before separation, recounted the history of injury and interventions.  The CI complained of chronic 2/10 right hip pain, which was controlled by medications (Darvocet and Vioxx).  Pain was exacerbated to 9/10 by crouching, driving, walking, running, and activities requiring flexion and rotation of the right hip.  The physical examination documented “walks with a pronounced limp of the right leg.”   The focused right hip examination revealed tenderness of the anterior inguinal region and greater trochanter.  Right hip active ROM was flexion of 110 (125) and abduction of 45 (45) degrees with full internal and external rotation.  There was pain at the extremes of ROM.  Strength and sensation were normal.  The diagnosis listed chronic hip pain.  A 29 April 2003 right hip X-ray was normal.  In the 29 April 2003 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI complained of daily right hip pain with associated thigh aching and stiffness.  Symptoms were exacerbated by prolonged sitting (> 30 min), squatting, activity, walking (> 1/4 mile), jogging, running, climbing, and cold wet weather and were relieved with medication (Tylenol, Vioxx, and Ultram).  The right hip examination revealed anterior and lateral tenderness.  Pain-limited right hip active ROM was flexion of 90 (125), abduction of 35 (45), adduction of 20 (45), and external rotation of 40 (45) degrees.  There was no diminution of ROM with repetitive testing.  Strength and deep tendon reflexes (DTRs) were normal.  The impression listed right hip fracture.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative) citing slight constant right hip pain, not requiring daily narcotic therapy, and rated as slight IAW USAPDA pain policy.  The VA assigned a 10% rating under the 5252 code (thigh, limitation of flexion of) based on the VA C&P examination a month after separation, citing right hip tenderness, ROM, painful motion, normal strength, and normal X-ray.  There was no thigh limitation of extension (5251), thigh limitation of flexion (5252), hip ankylosis (5250), thigh impairment of abduction, adduction, or rotation (5253), hip flail joint (5254), or femur fracture nonunion/malunion (5255) for consideration under the respective codes.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right hip condition.  

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.  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 20150603, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018765 (PD201500576)

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