RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00617
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050531

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

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 - 20050309	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Rt Hip Pain 	5251-5253	10%	Femoroacetabular Impingement Rt Hip 	5252	10%	20050806	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an onset of right hip pain with running in March 2003. Upon resumption of running that November this was followed by a “pop” with persistent pain.  Magnetic resonance imaging demonstrated joint impingement (anterior femoroacetabular), and surgical intervention (open femoral osteoplasty) ensued in August 2004 (10 months before separation).  Clinical STR entries documented an uncomplicated recovery, although the CI reported a recurrence of pain to pre-operative levels.  Post-operative range of motion (ROM) measurements in clinical entries were comparable with those presented below in the NARSUM, and included measurements of extension to 0 degrees (normal 20).  There were no post-operative examinations that documented mechanical impingement or any VASRD-ratable features, and imaging confirmed intact hardware and normal alignment.

The 18 February 2005 NARSUM (orthopedic) examination, 3 months before separation, documented non-specific pain that prohibited running and multiple general soldiering requirements, and was exacerbated by prolonged walking.  The physical examination recorded the use of a cane with “difficulty bearing weight on the right side,” “mild” tenderness, and intact neurovascular findings.  Measured ROM in degrees was flexion to 100 (normal 125), extension to “neutral” (e.g., 0), external rotation to 30 (normal 45), and abduction to 20 (normal 45), specifying painful motion. 

A 6 August 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, documented a “steady ache” with “flares 2-3 times per month” that limited walking and prolonged sitting.  The physical examination noted the CI no longer used a cane and recorded normal thigh strength without atrophy (no specific joint findings recorded).  Measured ROM in degrees was flexion to 120, extension to 20, external rotation to 30, abduction to 40, and adduction to 20 (normal 45), specifying painful motion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5251-5253 (limitation of extension, abduction, and rotation) was compliant with VASRD §4.71a criteria for the service evidence.  The VA’s 10% rating under code 5252 (limitation of flexion) was based on the C&P evidence and cited painful motion.  There was satisfactory evidence of painful motion from the NARSUM and C&P to support a 10% rating IAW VASRD §4.59, and the service ROM evidence additionally satisfied the 10% criterion for code 5251 (limitation of extension).  There was no ROM limitation, ankylosis, flail joint, or instability that would achieve a rating higher than 10% under any alternate code; other than consideration of analogous rating under 5299-5255 (femur, impairment of) which offers higher ratings for contiguous hip disability.  Members agreed, however, that in this case the analogous application of this fracture code was not sufficiently justified by VASRD §4.20 (analogous ratings) which satisfies compensable criteria under more applicable joint codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the right hip condition.

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or 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/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006531, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure