RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01370
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Health Care Specialist, medically separated for “right greater trochanteric bursitis…” with a disability rating of 0%.

CI CONTENTION:  Review of all conditions requested.  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 - 20040608	VARD - 20050303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Greater Trochanteric Bursitis…	5019	0%	Right Hip Condition	5299-5255	0%	20041007	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Greater Trochanteric Bursitis.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in April 2002 while performing physical training exercises.  Bone scans in 2002 and 2004 were normal.  Conservative measures did not bring ongoing relief.  Symptoms worsened around January 2003 and the CI was profiled with no running, lifting, or sit-ups. 

The 18 May 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right hip pain.  American Medical Association guidelines rated the pain as slight to moderate in intensity.  Physical examination showed no joint swelling but a positive FABER (pain on flexion, abduction and external rotation) test on the right and tenderness in the right inguinal area.  There were no motor or sensory deficits.  CI was able to heel and toe walk with no difficulty.  She was able working in her regular duties as a Licensed Practical Nurse (LPN) within the limits of her profile.  She took 3-4 pain pills per week.  Physical examination of the right hip showed flexion to 15 degrees (normal 125) and extension less than 5 degrees (normal 20).  Left hip flexion was 45 degrees (normal 125) and extension was less than 5 degrees (normal 20).  A diagnosis of chronic right hip trochanteric bursitis was rendered.  Physical therapy on 7 June 2004 showed right hip as flexion 120 degrees and extension was not recorded.  There was pain at the end of abduction with an average range of motion (ROM).

At the 7 October 2004 VA Compensation and Pension (C&P) evaluation, performed one month after separation, the CI reported chronic right hip pain and stiffness.  She reported it did not cause incapacitation.  She took pain medicine as needed and did stretching exercises.  Functional impairment was an inability to do prolonged running.  She did not lose time from work as a vocational nurse and was able to perform activities of daily living.  Physical examination of the right hip showed her general appearance was within normal limits on both sides.  ROM showed flexion to 125 degrees and extension to 30 degrees.  Pain had the major functional impact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5019 (bursitis), citing “without significant limitation of motion.”  The VA also rated the right hip condition 0%, coded analogously as 5299-5255 (impairment of femur), based on the C&P examination one month after separation, citing no slight knee or hip disability.  

Using the information in the treatment record, the panel determined that the CI’s right hip was essentially non-compensable based on the VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253).  However, according to VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Despite conservative therapy, the right hip pain was recurring and limiting.  Both examinations showed pain with motion.  The panel did not find sufficient evidence of a significantly disabling hip condition to justify a rating greater than 10%.  The panel unanimously agreed that IAW VASRD §4.40, §4.45, §4.59, and §4.71a, a disability separation rating of 10% was warranted for the right hip bursitis condition.

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 right bursitis pain condition, coded 5003.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel unanimously recommends a disability rating of 10%, coded 5003 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	
Right Greater Trochanteric Bursitis	5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008443, 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