RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01403
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmission System Operator Trainee, medically separated for “chronic pain, right hip” with a disability rating of 10%.  

CI CONTENTION:  The CI made a specific contention for his hip and knees 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 progression or complications of service-connected conditions after separation.  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 - 20021216	VARD - 20030821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Hip 	5099-5003	10%	Residuals, Stress Fracture Of Right Femoral Head 	5299-5251	10%	20030513	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Hip.    According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an atraumatic onset of right hip pain with physical training in May 2002.  A bone scan diagnosed a femoral neck stress fracture.  After a period of crutches and convalescent leave, follow-up radiographic (X-ray) and bone scan studies demonstrated that the stress fracture was healed; but, the CI experienced pain with resumption of strenuous activities.  There was STR documentation of a normal gait and grossly normal or modestly reduced range of motion (ROM).  Goniometric ROM measurements by physical therapy (11 days before the NARSUM) were flexion to 120 degrees (normal 125), extension to 15 degrees (normal 20), external rotation to 25 degrees (normal 45), abduction to 25 degrees (normal 45), and adduction to 10 degrees (normal 45); specifying pain at end ranges.

The 5 November 2002 NARSUM examination, 3 months before separation, documented non-specific hip pain aggravated by prolonged standing, sitting, walking, negotiating stairs, and load-bearing.  The physical examination recorded a normal gait and the absence of atrophy.  Measured ROM was external rotation to 25 degrees, abduction to 25 degrees, and adduction to 10 degrees.

A 13 May 2003 VA Compensation and Pension (C&P) examination, 3 months after separation, documented constant non-specific pain causing “discomfort with sitting, walking, weight-bearing, stretching.”  The physical examination recorded “grossly normal” joint findings.  Measured ROM was flexion to 110 degrees, extension to 30 degrees, external rotation to 60 degrees, abduction to 45 degrees, and adduction to 25 degrees; specifying painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5099-5003 (analogous to degenerative arthritis), cited the US Army Physical Disability Agency pain policy.  The VA‘s 10% rating under the analogous code 5251 (limitation of extension), cited painful motion.  There was no ROM limitation, ankylosis, flail joint or instability that would achieve a rating higher than 10% under any other applicable code available in VASRD §4.71a; other than consideration of analogous rating under code 5255 (femur, impairment of) which offers higher ratings for contiguous hip disability.  Members agreed, however, that the analogous application of this fracture code was not sufficiently justified by VASRD §4.20 (analogous ratings) in this case which satisfies compensable criteria under more applicable joint codes.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication of the chronic pain, right hip condition.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008470, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	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