RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01268
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “[left] iliotibial band syndrome (ITB),” with a disability rating of 0%.

CI CONTENTION:  The CI requests review all conditions.  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 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 - 20050408	VARD - 20051021	
Condition	Code	Rating	Condition	Code	Rating	Exam	
ITBS	5019	0%	Left Hip Greater Trochanteric Bursitis	5315-5019	10%	20050624	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Iliotibial band syndrome (ITBS).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s ITBS began in July 2003 during training without specific injury.  The CI reported left hip pain with shooting pain to the left knee.  The CI was evaluated by multiple orthopedic specialists and diagnostic imaging included X-rays, left hip magnetic resonance imaging (MRI), bone scan, and lumbar spine MRI.  The CI was diagnosed with left hip bursitis associated with chronic ITBS, unlikely to improve with surgery.  At an orthopedic evaluation on 21 September 2004 the physical examination showed painful, limited hip range of motion (ROM).  There was tenderness over the greater trochanter (GT), consistent with bursitis.  Strength and sensation of the left lower extremity (LE) were normal and equal to the right LE.  The left LE pain continued despite all conservative treatments and the prognosis was for a long, gradual recovery and doubtful if the CI would ever be able to perform the full duties of his MOS.  At the 21 March 2005 MEB NARSUM examination, 2 months prior to separation, physical examination showed pain with full flexion and internal rotation of the hip.  There was no tenderness over GT of the hip.  Physical therapy performed ROM for the MEB on 8 March 2005 and showed hip flexion of 109 degrees (normal 125), extension 20 degrees (normal 20), abduction 25 degrees (normal 45, adduction 15 degrees (normal 45) and external rotation 30 degrees (normal 45) with painful motion noted.  Left knee ROM was 139 degrees flexion (normal 140) and extension 2 degrees (normal 0) without pain.  

At the 24 June 2005 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported ITBS with constant pain involving the left hip and knee.  Physical examination showed a normal gait.  There was tenderness of the GT.  The left hip ROM was flexion 96 degrees, extension 26 degrees, abduction 26 degrees, adduction 25 degrees and external rotation 60 degrees, with painful motion noted.  There was no additional loss of ROM with repetitive motion noted by the examiner.  The left knee examination was normal with full ROM without pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition (ITB) 0%, coded 5019 (bursitis), citing “full range of motion and minimal to no tenderness to palpation.  Rated as “mild.” The VA rated the left hip condition 10% coded 5319-5019 (group XIX muscle injury- bursitis), based on the C&P examination 1 month after separation, citing “painful and limited motion of the left hip.”  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of thigh flexion or extension, thigh impairment or knee flexion or extension (5251, 5252; 5260, 5261).  However, there was evidence of painful motion of the hip supporting a 10% rating coded under 5019 or coded as 5299-5252 (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate the presence of hip ankyloses, flail hip joint, of femur impairment (5250,5254, 5255) for a rating under the respective codes.  There was no painful motion of the knee noted or any other ratable pathology of the knee for a higher rating under any VASRD knee codes.  The panel consider if alternatively coding and rating the ITBS condition IAW VASRD §4.73 (muscle injuries) supported a higher rating than 10%.  The rating criteria of 5314 (muscle group XIV [includes the ITB with hip flexion movements] are subjective with a 10% rating for “moderate” injury and 30% rating for “moderately severe injury.”  The panel agreed that the disability due to the ITBS proximate to separation could not be characterized as “moderately severe” based on normal strength at the cited orthopedic evaluation; no ratable finding of the hip (or knee) at the MEB NARSUM examination other than painful hip ROM; and, normal gait without evidence of additional loss of ROM with repetitive motion noted on the VA examination, 1 month after separation.  There was therefore no route to a rating higher than the 10% under any applicable VASRD code.  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 ITB syndrome, coded 5099-5019.  

BOARD FINDINGS:  In the matter of the iliotibial band syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5019 IAW VASRD §4.71a.  There are 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	
Left Iliotibial Band Syndrome	5099-5019	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009023, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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