RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01254
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic pain, right hip following stress fracture” with a disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities.  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 - 20040622	VARD - 20050208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Hip…	5099-5003	0%	Residuals, Stress Fractures of Right Femoral Neck and Greater Trochanter [Right Hip]	5299-5252	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Hip.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip pain condition began in August 2003 during Basic Training without specific injury or trauma.  Bone scan in September showed stress fractures of the right femoral neck and right greater trochanter.  Physical therapy and primary care treatment notes documented the CI’s limping gait had resolved by 21 January 2004.  The preponderance of subsequent treatment notes showed either painful right hip motion or decreased right hip motor testing often with pain.  Notes consistently documented a normal gait with gross motion of the right hip as normal through 3 March 2004.  
At the orthopedic specialist’s evaluation dated 12 February 2004, the CI complained of right hip pain and snapping.  Physical examination showed right hip painful motion with internal rotation, tenderness to palpation, and no contractures.  The specialist indicated the CI had residuals of his stress fracture and had developed coxa saltans (snapping hip) from iliopsoas tendonitis.  There was no surgical indication, and conservative therapy did not resolve the CI’s right hip pain.  The MEB forwarded “chronic right hip pain” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 March 2004, 5 months prior to separation, the CI reported right hip pain with stress fracture, bursitis, and snapping hip.  Physical exam showed right hip tenderness to palpation with mild decreased range of motion (ROM) of the right hip due to pain.  

The MEB NARSUM examination on 24 March 2004, 5 months prior to separation, noted complaints of continuous recurrent pain and popping in the right hip.  Pain was increased with activity and the CI could not march, jog, run, or do any of the aerobic functions of the Army Physical Fitness Test.  A repeat bone scan in March 2004 was abnormal with asymmetric tracer activity showing a healing stress fracture of the proximal femur on the right.  Physical examination showed the right hip with a positive Patrick’s test (painful motion) and tenderness to palpation.  Right hip ROM showed “abduction of the right hip was to 30 degrees (normal 45) and was terminated by pain.  Flexion of the right hip was to 30 degrees (normal 125) and caused pain.  There were no neurovascular changes.”  A follow-up bone scan in March, 2004 showed the stress fractures of your right hip were healing.  There was no VA Compensation and Pension (C&P) evaluation proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip pain condition 0%, using an analogous 5099-5003 code (degenerative arthritis), citing ROM limited by pain and rated as slight/intermittent with the US Army Physical Disability Agency (USAPDA) pain policy.  The VA also rated the right hip pain condition 0%, using an analogous 5299-5252 code (limitation of flexion of thigh), citing a non-compensable evaluation due to absence of medical evidence which showed the current clinical status of the residuals of the stress fractures of the femoral neck and greater trochanter of the right hip.

Almost all evaluation of the right hip, and the PEB disability description, documented painful motion of the right hip.  All examination in evidence documented sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  

The single examination which supported a 20% rating under the diagnostic codes for limitation of flexion (code 5252), was the NARSUM measurement of 30 degrees of forward flexion.  The NARSUM ROMs were not complete for all hip axis of motion, did not address repetitive motion, and were markedly different than the preponderance of the treatment notes and other evaluations of the right hip which showed at most a “mild” limitation of active ROM.  The panel also considered alternative 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 panel recommends a disability rating of 10% for the chronic right hip pain condition, coded 5299-5252.  

BOARD FINDINGS:  In the matter of the chronic right hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5252 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Chronic Pain, Right Hip…	5299-5252	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007545, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure