RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01539
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081224

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

CI CONTENTION:  The CI contends that his right hip condition from his fall in basic training continues to be problematic and should be changed to a higher rating.  The CI’s 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 - 20081023	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5299-5255	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in August 2006 after falling 36 feet onto his right hip.  According to the commander, the CI sustained a series of hip injuries for which he was at times denied access to medical attention.  In January 2007 the CI was told he had arthritis and profiled for his hip condition.  CI reported his hip gave way during the last fitness test he took and this caused intense pain.  In May 2008, the CI fell on his hip twice while deployed to Iraq.  He had difficulty ambulating due to pain in the right hip, and was sent to Germany for further tests and was told that surgery would not help and that he would walk with a limp for the rest of his life.  In July 2008, x-rays noted possible minimal degenerative osteophyte formation of the right head of the femur.  Magnetic resonance imaging (MRI) was normal.  He was treated for 2 years for bursitis of the right hip with injection and physical therapy which did not help.  

The 11 July 2008 Orthopedics examination showed no abnormalities of the hip by radiology findings.  On 20 July 2008, Orthopedics examination documented tenderness over the greater trochanter bone, pain with abduction and subluxation of the fascia with limited range of motion in almost all planes.  Flexion was 100 degrees (normal 125 degrees) and extension to 15 degrees (20 degrees).  At the 21 July 2008 primary care examination the CI presented on crutches and avoiding weight-bearing on the right hip.  There was pain in all directions of motion and no atrophy.  Strength was normal with resistance to bending.  The CI was able to sit comfortably in a chair and flexed his hip when putting on clothes despite difficulty flexing during examination.  

At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 11 August 2008, 4 months prior to separation, the CI reported tenderness over the right trochanter with repetitive right hip flexion of 82, 78, and 80 degrees.  The 26 August 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of extreme pain while walking.  The CI rated the pain 6-7/10 in intensity on a daily basis while taking medication.  He reported the pain was sharp and ran through his hip and into his leg and foot.  Medication, rest and wet heat helped the pain.  He was no longer able to swim or run.  He had to sit to put on his pants.  His fitness test (APFT) was completely disallowed.  He failed the last APFT due to his hip giving out during the run which caused intense pain.  He took a narcotic medication once or twice per day for pain and also took anti-inflammatory medication 1-3 times per day.  The CI had not performed the duties of his MOS since redeploying in July 2008. His profile allowed him to carry and fire a weapon and wear chemical defense gear.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5299-5255 (femur, impairment of mal union; slight hip disability), citing slight impairment and application of IAW VASRD 4.10, 4.40, 4.45 and 4.59. 

Physical examination showed the CI arose from his chair with moderate difficulty and walked to the examination room with an antalgic gait favoring his right hip.  There was significant tenderness over the right greater trochanter bone of the hip.  Extension was significantly limited by pain.  Range of motion (ROM) by goniometer showed flexion to 82 degrees, extension to 13 degrees and abduction to 34 degrees with little change after repetitions.  There was no external deformity, atrophy or muscle spasm demonstrated.  Pain was the limiting factor but was rated as slight.  

The panel then discussed whether a pathway to a higher rating was possible under the 5299-5255 code.  The CI had an antalgic gait, significant tenderness over the greater trochanter bone of the hip and pain limited motion in nearly all planes, especially extension.  The APFT test was completely disallowed since his hip had given out during his last test resulting in great pain and he was unable to run or engage in other activities.  Yet the radiology findings showed limited evidence of hip pathology and CI was observed sitting comfortably and able to put on his clothes without difficulty in flexion.  There was no atrophy, muscle spasm, or loss of strength.  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 left hip disability condition.  

BOARD FINDINGS:  In the matter of the right hip pain condition and IAW VASRD §4.71a, the panel within the panel’s scope of review for consideration.  There are 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 , w/atchs
Exhibit B.  Service Treatment Record

AR20170008819, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

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