RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01549
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Ammunition Specialist, medically separated for “bilateral hip pain,” with a disability rating of 20%.

CI CONTENTION:  “Review all 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 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 - 20081112	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	10%	No VA Exam in Evidence	
	5099-5003	10%		
Low Back Pain	Not Unfitting 		
Post-Traumatic Stress Disorder			
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted right hip pain early in basic training.  The examination was normal as was an X-ray.  A bone scan on 12 August 2005 showed stress changes in the ankles and feet, but the hips were unremarkable.  The CI was treated with duty limitations, medications, and physical therapy, but had persistent pain.  A repeat bone scan on 13 October 2005 showed increased uptake, right greater than the left, of the adductor insertions into the femurs consistent with an enthesopathy (an abnormality of the insertion of a tendon or ligament).  X-rays of both hips on 24 October 2005 were normal.  In primary care on 26 April 2006, she reported bilateral hip pain.  On examination, the hips were tender and motion was painful.  The hips were stable though and the range of motion (ROM) full.  The gait and stance were also normal.  Her pain persisted despite treatment and MRIs of both hips were accomplished on 18 August 2006.  These were normal.  The CI was then recommended for MEB as she had been on a profile for an extended period without resolution of her pain.  

On 19 January 2007, she was noted to have a slow, but symmetric gait.  The ROM was full but painful.  It was recommended that she be considered for cross-training.  The CI then became pregnant.  The MEB process was then put on hold until after the delivery of her child as the evaluation for the MEB could not be completed until then (X-rays, etc.).  

Repeat MRI studies were accomplished on 14 February 2008.  It was noted that the left hip might have arthritis and that there might be bilateral stress reaction, but there were no definitive findings.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 March 2008, 10 months prior to separation, the CI reported chronic bilateral hip pain.  The examination was noted to be normal other than mild discomfort with motion (primarily internal rotation) of the hips.  X-rays of the hips on 31 March 2008 were normal.  The MEB NARSUM examination dated 12 September 2008, 5 months prior to separation, noted complaints of constant pain aggravated by staying in one position for more than 15-30 minutes.  The ROM was painful and reduced as charted below.  The CI has not requested a VA Compensation and Pension evaluation.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Hip (Thigh) ROM
(Degrees)	MEB ~5 Mos. Pre-Sep	
	Left	Right	
Flexion (140 Normal)	106	97	
Extension (0 Normal)	16	15	
External Rotation (45)			
Abduction (0-45)	35	60	
Adduction (45)	15	10	
Comment	Painful Motion	
§4.71a Rating	10%	10%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain condition 20%, analogously coded 5099-5003 (arthritis, degenerative), citing limitation of motion of one major joint for each hip.  The panel noted that each hip was separately rated at 10% and then the bilateral factor applied for a final rating of 20%.  The panel considered the evidence.  The limitation in motion recorded was not compensable under the codes specific for the hip.  Painful motion supported a 10% rating for each hip under multiple codes including 5251 (limitation of extension), 5252 (limitation of flexion), 5253 (limitation of abduction, adduction, or external rotation).  This provided no advantage to the CI over the 5003 code used by the PEB.  No route to a higher rating was found by the panel.  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 for the bilateral hip condition.  

Contended PEB Conditions:  Low Back Pain and Post-Traumatic Stress Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was profiled or implicated in the commander’s statement.  Both were judged to meet retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

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.  In the matter of the contended low back pain and post-traumatic stress disorder conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20150622, w/attachments
Exhibit B.  Service Treatment Record

AR20170008821, 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