The RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01317
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Avionics Systems Repairer, medically separated for “chronic pain, right hip, due to tendonitis,” with a disability rating of 10%.

CI CONTENTION:  “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 - 20011113	VARD - 20020206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Hip, Due to Tendonitis	5099-5003	10%	Right Hip Tendonitis	5024-5251	0%	Service Treatment Records
(STR)	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Hip, Due to Tendonitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right hip condition began in approximately September 1999 as a result of training.  The CI had antecedent ankle pain, which resolved, and symptoms of shin splints bilaterally in the months leading up to a bone scan dated 18 February 2000, which demonstrated moderate to severe shin splints, no evidence of stress fractures, and mild stress related changes of the femurs.  On 10 March 2000, the CI noted bilateral hip pain, which was worse on the right.  Treatment consisted of Tylenol (acetaminophen, a pain reliever) and Naprosyn (naproxen, a nonsteroidal anti-inflammatory drug (NSAID)) along with crutches and an updated profile.  By 27 March 2000 the CI noted resolving hip pain and wanted to discontinue use of the crutches.  On 12 April 2000 the CI noted right lateral hip pain.  On examination her gait was normal and she had tenderness to palpation of the right lateral hip/greater trochanter region without anterior or posterior hip pain or pain in the inguinal area.  Trochanteric bursitis was considered the most likely diagnosis.  At a sports medicine consultation on 28 April 2000 the CI was tender to palpation on the right hip just inferior to the lateral aspect of the iliac crest with no palpable defects.  There was no tenderness to palpation over the greater trochanter.  Ober’s test (to determine an inflamed tensor fascia lata (TFL), a muscle to flex or abduct the thigh) was positive.  The assessment was right lateral hip pain probable secondary to a tight iliotibial band (ITB) with symptoms at the origin of the ITB.  On 5 June 2000 the CI reported slight improvement with sports medicine exercises.  In October 2000 the CI reported sharp, shooting right hip pain with numbness and a tingling sensation for 2 weeks, which bothered her to run, walk, sit, stand, or sleep.  Treatment consisted of Indocin (indomethacin, an NSAID).  The CI had a flare of pain in February 2001 after running.  At a physical therapy evaluation in March 2001 the CI was noted to have a leg length discrepancy with the left longer than the right by 1/4 inch for which a heel lift to be worn in the right shoe was prescribed.  When the CI felt a slight increase of pain in the hip, the heel lift was discontinued and a trial of ultrasound to the right TFL along with stretches were instituted.   Orthopedic evaluation in April, May and June 2001 noted a full ROM of the right hip with tenderness to palpation of the anterior iliac crest, while in June 2001 the CI complained of a snapping sensation several times a day in the area of the iliac crest.  The examiner’s assessment was tendonitis of the right hip with a snapping hip. 

During 15 August 2001 the MEB examination (recorded on DD Forms 2807-1 and 2808, 5 months prior to separation, the CI reported she was told that “it was bursitis in my hip” and her “right hip joint hurts all the time.”  The examiner noted right knee popping, but did not record any details about the hip, although chronic hip pain was listed in the section of significant or disqualifying defects.  

The 15 August 2001 MEB NARSUM examination, 5 months prior to separation, noted complaints of progressive right hip and right leg pain, which had worsened; and, she had a lot of trouble doing physical activity and even some trouble walking.  Physical examination showed the right knee popped.  The NARSUM examiner indicated there was a full ROM at orthopedic examinations on 30 April and 28 June 2001 and noted the orthopedic examiner felt the CI had right hip tendonitis for which surgery would not be appropriate.  The NARSUM examiner’s diagnosis was tendonitis of the right hip, chronic and refractory to multiple treatments.  At an Emergency Room visit on 27 August 2001 where the CI was evaluated after being hit while in a pickup [truck], she denied any injury, but noted she had right hip pain, which “was baseline, as she is going through Med Board for pain.”  On examination of the right hip, the CI had gluteal pain with internal rotation and the active ROM of the hip was intact.  A 1 November 2001 NARSUM addendum, 2 months prior to separation, noted the CI had a normal gait and toe-and-heel walking without a limp.  She was able to go into and arise from a full squatting position smoothly without any difficulty.  The area of maximum tenderness was at the TFL region.  She had no crepitus (grinding) with the hip ROM, which was full.  When the CI was supine she had 120 degrees of flexion, 20 degrees of extension, 40 degrees of abduction, and 25 degrees of adduction.  With the hip flexed to 90 degrees, there was 30 degrees of internal rotation and 40 degrees of external rotation, while with the hip in extension, the internal rotation was 40 degrees and the external rotation was 50 degrees.  No discomfort was present.  She had straight leg raising actively without hesitation or discomfort.  Motor testing revealed strong hip flexors and abductors without discomfort.  The rest of her L2-S1 motor and sensation testing was normal.  The contralateral hip had the identical ROM and strength.  The examiner opined the basis for the diagnosis of tendonitis was persistent discomfort at the region of the TFL. There was no VA examination proximate to separation in evidence.  
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain, right hip, due to tendonitis 10%, coded 5099-5003 (arthritis, degenerative), citing the U.S. Army Physical Disability Agency (USAPDA) pain policy.  The VA rated right hip tendonitis (also claimed as pain) 0%, coded 5024-5251 (tenosynovitis-thigh, limitation of extension), based on the STR, citing the CI had subjective complaints of pain, without any abnormal objective clinical or radiological finding to include painful or limited motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of extension, flexion or thigh impairment (5251, 5252, or 5253).  However, there was evidence of chronic pain supporting a 10% rating.  In the absence of hip ankylosis (5250), hip flail joint (5254), or femur impairment (5255) there was no VASRD §4.71a route, including use of the muscle Groups XIV and XVII (5314 and 5317) IAW VASRD §4.73, to a rating higher than the 10% adjudicated by the PEB.  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 chronic pain, right hip, due to tendonitis condition.  
______________________________________________________________________________

BOARD FINDINGS:  In the matter of the chronic pain, right hip, due to tendonitis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170007553, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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