RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01081
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20040702

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Staff Nurse, medically separated for “status post left acetabuloplasty with labral repair, osteal chondroplasty of the femoral head and surgical dislocation after trochanteric osteotomy [left 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 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 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 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 - 20040415	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Left Acetabuloplasty… [Left Hip Pain]	5009-5003	10%	No VA Disability Claim Filed	
Status Post Labral Tear Debridement…	Cat II		
Status Post Hardware Removal	Cat III		
Mild Hip Dysplasia	Cat III		
Status post Left Tibial Internal Rotational Osteotomy	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:

Left Hip Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip pain condition began in the Spring of 1999 with intermittent left hip pain but increased greatly 28 October 1999 after a Physical Readiness Test (PRT).  The CI was initially diagnosed with a left hip labral tear and underwent hip surgery in January 2000.  At that time, the CI was noted to walk with her left foot turned out approximately 70-90 degrees.  After the surgery, the CI was evaluated by numerous surgeons.  The consensus was a problem in the left hip as well as the left tibial misalignment (femoral anteversion in combination with tibial antetorsion).  The CI subsequently underwent a left high tibial internal rotational osteotomy on 23 April 2001.  Radiographic imaging (X-rays, CT and MRI) showed good healing of her knee with tibia and hip.  However, during a subsequent pregnancy the CI began to experience left hip pain again.  The MEB forwarded “labral tear status/post debridement,” “status/post left tibial internal rotational osteotomy,” “osteochondrosis femoral head status/post osteal chondroplasty” and “mild hip dysplasia” for PEB adjudication.

At a physical therapy evaluation on 14 Oct 2003, 9 months prior to separation, the CI complained of an intermittent pinching pain with hip flexion.  Physical examination showed flexion of 108 degrees (normal 125), extension 10 degrees (normal 20), abduction 35 degrees (normal 45), adduction 15 degrees (normal 45) and external rotation 50 degrees (normal 45) with painful motion.

The MEB NARSUM examination on 10 February 2004, 5 months prior to separation, noted complaints of clicking and popping of the left hip with pain while running, walking and prolonged standing.  Physical examination showed forward flexion to 115 degrees (normal 125), external rotation 45 degrees (normal 45), abduction 45 degrees (normal 45), adduction 15 degrees (normal 45) with painful motion.  The CI did not file a VA disability claim; and therefore, there was no VA Compensation and Pension evaluation for Board review.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip pain condition 10%, analogously coded 5009-5003 (degenerative arthritis).  
The PEB subsumed the status post labral tear debridement into the status post left acetabuloplasty condition as a Category II condition (contributed to the Category I condition but is not separately unfitting).  The Board agreed that there was insufficient limitation of range of motion to provide a minimum rating using VASRD codes 5251 (thigh, limitation of extension), 5252 (thigh, limitation of flexion of) or 5253 (thigh, impairment of).  In addition, there was no indication of a flail joint of the hip to support an 80% rating using code 5254, ankylosing of the hip to support a 60% rating using code 5254 or malunion of a femur fracture to support a 10% or higher rating using code 5255.  Left knee CT completed 29 April 2003 showed healing of the tibial osteotomy and therefore does not support rating under code 5262 (tibia and fibula, impairment of, nonunion of or malunion).  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 left hip pain condition.

Contended PEB Conditions:  Status Post Hardware Removal; Mild Hip Dysplasia; and Status Post Left Tibial Internal Rotational Osteotomy.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the status post left acetabuloplasty with labral repair, osteal chondroplasty of the femoral head and surgical dislocation after trochanteric osteotomy [left hip pain] condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended status post labral tear debridement through arthroscopy condition, the Board unanimously recommends no change from the PEB determination as not separately unfitting.  In the matter of the contended status post hardware removal; mild hip dysplasia; and status post left tibial internal rotational osteotomy conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20150609, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 23 Mar 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						   XXXXXXXXXXXXXXXXXX
	     				  	   Assistant General Counsel
						   (Manpower & Reserve Affairs)