RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00629
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “right hip pain secondary to a stress fracture of the femoral neck,” with a disability rating of 0%.  

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 – 20070913	VARD - 20080828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain Secondary to a Stress Fracture of the Femoral Neck	5099-5003	0%	Status Post Stress Fracture of Right Femoral Neck with Residual Chronic Pain	5255-5253	20%	20080417	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Right Hip Pain Secondary to a Stress Fracture of the Femoral Neck.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s non-traumatic right hip condition began in January 2007.  A bone scan in February 2007 showed mild focal uptake in the right femoral neck suggestive of a stress fracture.  Despite treatment, the right hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military training requirement and the CI was referred for an MEB.  The MEB forwarded “chronic right anterior hip pain with history of neck stress reaction or fracture” for PEB adjudication.  
The MEB NARSUM examination on 23 August 2007, 2 months prior to separation, noted complaints of chronic right hip pain.  Physical examination showed active full range of motion (ROM) of the right hip with pain in flexion, abduction, adduction, internal and external rotation with hip flexed and extended.  There was no instability or weakness.  Sensation, reflexes, and vascular testing were normal.  X-rays of the right hip and pelvis were normal.  Right hip ROM measurements performed by physical therapy (PT) on 7 September 2007 showed pain limited motion as charted below.  The CI could cross both legs and toe out over 15 degrees.  

At the 17 April 2008 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported chronic hip pain with weakness, giving way, lack of endurance and fatigability.  Pain was 8/10 and elicited by physical activity and relieved by rest medication and use of crutches (2 out of every 8 weeks).  Physical examination showed an abnormal gait with limping to the right.  The right hip was tender and had painful motion as charted below.  The examiner stated that “on the right, the joint function is additionally limited by the following after repetitive use:  pain; fatigue, weakness, lack of endurance, incoordination and pain has the major functional impact.  The above additionally limit the joint function by 10 (flexion) degrees.”  X-ray of the right hip was normal.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Hip (Thigh) ROM
(Degrees)	MEB ~2 Mo. Pre-Sep	PT ~2 Mo. Pre-Sep	VA C&P ~6 Mo. Post-Sep	
			Active	Degree that Pain Occurs	
Flexion (125 Normal)	FAROM with Pain	90,85,85	80	70	
Extension (20)		10,10,10	20	15	
External Rotation (45)		-	25	25	
Abduction (0-45)		22,22,24	20	10	
Adduction (45)		-	5	5	
Comment	Painful Motion	Able to cross both legs; Painful motion	Flexion additionally limited after repetitive use by 10 (flexion) degrees	
§4.71a Rating	10%	10%	10% (VA 20%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5099-5003 (arthritis, degenerative), citing application the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right hip condition 20% coded 5255-5253 (femur, impairment of-thigh, impairment of), based on the VA C&P examination 6 months after separation, citing limitation of abduction to 10 degrees due to pain.  All examinations in evidence documented sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The VA examination indicated pain onset on abduction to 10 degrees, without noting limitation of abduction at that level.  The Board adjudged that the Service examinations had the highest probative value for rating at separation as they were detailed and closest to separation.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or thigh impairment for greater than a 10% rating (codes 5251, 5252, or 5253).  The Board next considered analogous rating analogous to code 5255 (femur, impairment of) and adjudged that the CI’s impairment at separation did not more nearly approximate the “moderate” hip disability level to warrant the next higher (20%) rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right hip condition, coded 5299-5255.  

BOARD FINDINGS:  In the matter of the right hip condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5255 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 Condition	5299-5255	10%	

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 
XXXXXXXXXXXXXXXXXX, AR20170000307 (PD201500629)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA