RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00602
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Air Traffic Control Operator, medically separated for “arthritis, right hip,” with a disability rating of 10%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 - 20040315	VARD - 20040929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis, Right Hip	5003	10%	Arthritis, Right Hip (Claimed as Chronic Right Hip Pain
with Femoral Head Dysplasia)	5003-5251	10%	20040823	
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 complained of gradual onset of right hip pain approximately 2 years prior to referral for MEB.  Right hip and femur X-rays on 12 August 2002 showed moderate right hip joint degenerative changes.  On 29 January and 19 April 2003, orthopedic surgery performed right hip injections with local anesthetic and corticosteroid, which provided temporary relief.  The 19 June 2003 aviation medicine right hip examination revealed no deformity, no tenderness, and full range of motion (ROM).  On 23 July 2003 orthopedic surgery documented pain-limited right hip ROM values of flexion of 90 (125 normal), extension of 20 (20), and external rotation of 15 (45) degrees.  A right hip X-ray and MRI on 8 August 2003 showed mild right hip joint osteoarthritis.  In the 28 January 2004 NARSUM by orthopedic surgery, 5 months before separation, the CI complained of a several year history of progressively increasing right hip and groin pain.  He had no active treatment and did not require a cane or a crutch.  The CI did not experience significant relief from nonoperative interventions (activity modification, physical therapy [PT], hip injections, and nonsteroidal anti-inflammatory medications).  He was no longer able to run, ambulate 2-1/2 miles, or bike.  Goniometer measured right hip ROM values were flexion of 80 (125), extension of 10 (20), and external rotation of 10 (45) degrees.  With flexion, he had a forced external rotation and abduction.  Strength and sensation were intact.  The surgeon recounted the X-ray findings and opined that no current surgical intervention was indicated.  The diagnosis listed right hip arthritis.  In the 23 August 2004 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported he had occasional, minor, right hip pain.  Flare-ups of discomfort were caused by standing (> 30 minutes) or walking (1 > hour).  He recalled no injury to his right hip and did not use a cane or require a lift in his shoes.  The only limitation in any of his activities was in standing.  The physical examination documented “Gait is normal when he walks slowly.  When he picks up the pace, he has a very subtle limp on the right leg.”  “He has normal range of motion in all of his joints.  Specifically, he has normal range of motion in his right hip.”  Strength and sensation were normal.  The examiner recounted the X-rays and the diagnosis listed mild right hip arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5003 code (arthritis, degenerative) citing right hip arthritis.  The VA assigned a 10% rating under the 5003-5251 codes (arthritis, degenerative-thigh, limitation of extension of) based on the VA C&P examination 2 months after separation, citing painful or limited motion of a major joint.  There was no compensable thigh limitation of extension (5251), thigh limitation of flexion (5252), or thigh impairment of abduction, adduction, or rotation (5253) for consideration under the respective codes.  There was no hip ankylosis (5250), 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 conditions 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 20150602, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000279 (PD201500602)

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