RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01536
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030131

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E3, Automated Logistical Specialist, medically separated for bilateral hip pain, with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  Her 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 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 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 Board’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 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 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 - 20021114	VARD - 20040401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5009- 5003	0%	Right Hip, Chronic Pain	5255	NSC 	20040323	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hip condition began during Basic Training.  She was first seen on 14 September 2000 and reported a 7 week history of left hip pain due to running.  She was thought to have a possible stress fracture and treated with restricted activities.  A bone scan in November 2000 showed a stress fracture of the left inferior pubic ramus (the pelvic bone on the left).  When repeated on 2 February 2001, healing was present although the scan remained abnormal.  She subsequently also reported right hip pain although this side had been quiet on the bone scans.  She was then diagnosed with bilateral snapping hip syndrome (a condition in which a tendon “snaps” over a hip bone).  She continued duty modifications, medications, and physical therapy, but her pain persisted.  X-rays of the left hip on 25 February 2002 were normal.  A repeat bone scan on 1 May 2002 showed mild symmetric uptake over both hips consistent with stress reactions without fractures.  It was noted that primarily her right hip was symptomatic.  In physical therapy on 11 July 2002, she reported an increase in the right hip pain following a 5 hour convoy ride 2 days earlier.  Bilateral tenderness was noted on the examination.  X-rays of the pelvis and hips that day were normal.  She was continued in physical therapy and referred to orthopedics for a permanent profile.  There it was noted that she had been on a profile for over 1 year and the CI was referred for an MEB.  On examination, the front of the right hip was tender.  The range of motion (ROM) was noted to be full.  The MEB NARSUM examination was accomplished by the same orthopedist the same day, 5 months prior to separation.  The CI reported pain with running and prolonged standing, sitting and excessive walking.  Medications had not helped. Physical therapy had improved her pain, but did not resolve it.  Her gait was normal.  X-rays and bone scan were noted to be unremarkable.  The MEB forwarded bilateral hip pain, right greater than left, for PEB adjudication.  At the 23 March 2004 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported occasional right hip pain.  Her gait was normal and pain free.  The ROM of the hips was full and pain free.  Tenderness was absent.  She could toe and heel walk.  X-rays of the hips and pelvis were normal.  The examiner noted that there was no evidence of current pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 0%, analogously coded 5003 (degenerative arthritis), citing full range of hip motions with a normal gait.  X-rays and bone scan were unremarkable.  The condition was rated for pain in accordance with the USAPDA pain policy.  The VA denied service connection of the hip condition, based on the VA C&P examination 14 months after separation, citing no evidence that the claimed condition existed.  It coded the condition 5255, impairment of the femur (thigh bone).  The panel considered the evidence.  At the time of separation, the CI had full and pain free motion without radiographic evidence of ongoing pathology.  Her gait was normal and she only had difficulty with extremes of activity such as prolonged walking, sitting, standing or with running.  She had been diagnosed with a left pubic ramus stress fracture and bilateral stress reactions.  However, the evidence proximate to separation and following separation indicates that these conditions had resolved over time as would be clinically expected.  Absent painful motion, limited motion, or radiographic findings, the panel found no route to a compensable rating for the hip condition.  The panel considered if the hips were separately unfitting, but absent clinically significant pathology, found no evidence to support a finding that one hip was unfitting absent the pain from the other.  Regardless, absent painful motion, limited motion, or radiographic findings, the Board found no route to a compensable rating for the hip condition separately or together, rendering the question moot.  The Board did consider the application of VASRD §4.40 (functional loss), but noted that the CI did not report limitations in normal activities.  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 bilateral hip pain condition.  

BOARD FINDINGS:  In the matter of the bilateral hip pain 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150621, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006632 , 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