RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00706
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030903

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “bilateral greater trochanteric bursitis” with a disability rating of 0%.  

CI CONTENTION:  The CI states that her condition continues to worsen.  The 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 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 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 - 20030709	VARD - 20031021	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Greater Trochanteric Bursitis	5019	0%	Right Hip, Trochanteric Bursitis	5255-5019	0%	20030730	
			Left Hip, Trochanteric Bursitis	5255-5019	0%	20030730	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Greater Trochanteric Bursitis.  The PEB combined the bilateral hip conditions under a single disability rating, coded 5019 and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain was identified by physical therapy in April 2001.  Radiographic imaging in April (X-ray) and May 2001 (bone scan) were normal.   

At the 9 May 2003 MEB examination (documented on DD Form 2808), 4 months prior to separation, the physical examination showed tenderness of the bilateral hips (trochanteric regions).  At the 5 June 2003 MEB NARSUM examination, 3 months prior to separation, the physical examination showed tenderness of the bilateral hips (at the trochanteric bursae) and “normal” range of motion (ROM).  

At the 30 July 2003 VA Compensation and Pension (C&P) evaluation, one month before separation, the CI reported only occasional discomfort in the hips, and that she was asymptomatic and did not require any treatment.  The physical examination showed no evidence of tenderness, discomfort, or loss of mobility.  ROM showed flexion to 125 degrees (normal), external rotation and abduction to 45 degrees (both normal) and adduction to 30 degrees (normal 45).  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the bilateral hip condition, coded 5019 (bursitis), citing no limitation of motion.  The VA rated 0% each for the right and left hip conditions, analogously coded 5255-5019 (femur, impairment-bursitis), based on the C&P examination 1 month before separation, citing a non-compensable examination without objective painful or limited motion or femur malunion with knee or hip disability.  

The panel first considered if the individual hip conditions, having been de-coupled from the combined PEB adjudication, were reasonably justified as separately unfitting as established above.  In this case, both hips were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; and, both were profiled.  There were no unilateral distinctions with regards to clinical features or fitness considerations.  It is speculative to conclude that the disability confined to a single hip would have rendered the CI incapable of performing her MOS; and, it is reasonable to surmise that it was the combined effect of both hips which rendered her unfit.  Furthermore, the bilateral diagnosis supported a single 5003 based rating for “2 or more major joints....”  Members agreed, therefore, that there were insufficient grounds for recommending separate right and left hip disability ratings in this case.  

The panel then considered the rating recommendation.  The panel discussed whether there was STR evidence of a chronic disability.  There was STR evidence of tenderness of the bilateral hips at the trochanteric bursae, however there was no evidence of painful motion and no evidence of chronic disability after separation.  Pre-separation radiographic studies showed no evidence of bony deformity, arthritis, stress fractures, or other chronic pathology.  There was no documentation of ankylosis or any limitation of thigh flexion (5252); extension (5251); or abduction, adduction or rotation (5253) to support a higher rating.  There was no documentation of nonunion or malunion (5255) of a femoral neck or shaft fracture for a higher rating under the femur codes.  Due to lack of STR evidence of painful motion and documentation of chronicity, separate ratings of 0% would be of no benefit to the member.  

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 for the bilateral hip condition.  

BOARD FINDINGS:  In the matter of the bilateral greater trochanteric bursitis 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 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

AR20170006551, 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