RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01492
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cargo Specialist, medically separated for “pain due to right hip anterior iliac spine bone bruise,” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20021009	VARD - 20030716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Due to Right Hip Anterior Iliac Spine Bone Bruise	5099-5003	0%	Right Hip Anterior Iliac Spine Bone Bruise	5253-5003	20%	20030519	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Pain Due to Right Hip Anterior Iliac Spine Bone Bruise.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in November 2000 when falling during a run.  The MEB forwarded “right hip anterior iliac spine bone bruise” for PEB adjudication.

At a primary care clinic visit in March 2001, the CI complained of a 4-month history of right hip pain.  The examiner found the right hip was tender to palpation at the anterior superior iliac crest and trochanteric areas.  The CI was given Naprosyn for pain and inflammation.  At a primary clinic appointment on 9 April 2001, the CI reported constant right hip pain that varied with activities and walking.  The examiner found tenderness to palpation at the area.  The CI was given Elavil and Naprosyn.  At a primary clinic appointment on 4 May 2001, the CI reported right hip pain and right knee pain.  The CI stated she had physical therapy treatment in April 2001, but the pain persisted.  The CI was given a non-steroidal anti-inflammatory drug for the pain and inflammation and Flexeril.  On 7 May 2001, the CI was seen in the emergency department with a complaint of right hip pain for 5 months.  The CI stated the pain increased, exacerbated, with running and a bus ride.  Magnetic resonance imaging (MRI) study of the hips performed on 2 July 2001 found the right anterior superior iliac spine had a bone bruise or contusion that was probably responsible for the CI’s persistent pain.  The MEB NARSUM examination, undated, in the CI’s file noted a complaint of right hip pain.  The CI stated the pain was “always there” and “worsened by standing longer than 30 minutes every hour or walking 1 mile or running anything greater than 100 yards.”  She reported no relief with physical therapy or multiple anti-inflammatories.  Physical examination showed the CI presented with a non-antalgic gait.  Her range of motion (ROM) was equal and symmetrical in both hips and noted as flexion 100 degrees (125 degrees normal), internal rotation 15 degrees (40 degrees normal), external rotation 45 degrees (60 degrees normal) and abduction 60 degrees (45 degrees normal).  

At the 19 May 2003 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported she had problems with her right hip.  The CI reported pain with ambulation, running and standing for prolonged periods of time.    The CI also stated she had flare-ups when she sat in a chair or sat in a car for greater than 3 hours.  The CI denied any weakness, stiffness, swelling, instability or locking.  Physical examination showed goniometric active ROM measurements of the right hip were forward flexion at 100 degrees, abduction 20 degrees, and adduction, external and internal rotations were normal in their respective ROMs (25, 60, and 40 degrees); however, the CI complained of pain associated with movement of the hip ranging from 8 to 10 on a scale of 1 to 10 with 10 being the most severe.  MRI studies demonstrated a bone bruise at the anterior superior iliac spine on the right side of the body.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 0%, coded analogously as 5099-5003 (degenerative arthritis) citing an unremarkable examination and normal radiographs. The VA rated the right hip condition 20% dual coded as 5253-5003 (impairment of thigh and degenerative arthritis), based on the VA C&P examination 6 months after separation, citing X-ray evidence showing involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations.  The Board noted reports of pain with use, radiographic evidence of bony pathology, and objective findings on multiple treatment records of tenderness to palpation of the right hip. Board members agreed that the evidence supports a 10% rating for painful motion and function loss IAW §4.59 and §4.40.  The evidence did not support a rating for thigh limitation of flexion to 30 degrees, or limitation of abduction lost beyond 10 degrees for a 20% rating.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the right hip condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right hip condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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	
Pain Due to Right Hip Anterior Iliac Spine Bone Bruise	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150613, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002492 (PD201501492)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA