RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01617
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Health Care Specialist, medically separated for “chronic left hip pain” with a disability rating of 10%.  

CI CONTENTION:  “I have not received benefits from the VA.  My application was denied although I had 10% from the Army separation.”  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 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 - 20070608	VARD - 20090113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain...Left Femoral Neck Stress Fracture w/ Partial Gluteus Medius Tear	5099-5003	10%	Stress Fracture Left Femoral Neck	5255	0%	STR	
			Left Partial Gluteus Medius Tear	5317	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Femoral Neck Stress Fracture with Partial Gluteus Medius Tear.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip condition began while in Basic Combat Training.  No injury or trauma was reported.  Radiologic imaging revealed a stress fracture of the left femoral neck.  The CI’s symptoms were progressive in nature but, became refractory to numerous temporary profiles and conservative treatment.  

The 13 March 2007 MEB NARSUM examination, 5 months prior to separation, the CI’s chief complaint was “left hip pain” which was aggravated by all impact activities.  Her physical examination (PE) revealed a “minimally” antalgic gait as she utilized crutches for ambulation.  Passive range of motion (ROM) revealed pain near upper limits of normal.  

During the 13 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported left hip tenderness as well as painful and decreased ROM.  Active flexion of the left hip was 61 degrees and the CI was able to cross legs during adduction.  On 3 and 7 May 2007, nearly 2 months after the NARSUM and 3 months prior to separation, the CI was evaluated by PT and noted left hip flexion a “WNL” (within normal limits) with pain at end ROM.  Her gait and stance was listed as “abnormal non-antalgic gait.”  The CI was no longer taking pain medications for her condition and her pain intensity was described as “…a very mild achy pain that decreases with initial walking activity but then returns by the end of the day.”  The CI failed to report for her scheduled VA Compensation and Pension (C&P) examination on 2 and 8 January 2009, but a VARD dated 13 January 2009 noted a 0% rating.  Therefore, the Board’s final rating recommendation will be based upon the STR and MEB-driven documents.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left hip pain condition (and subsumed partial muscle tear) at 0%, analogously coded 5099-5003 (arthritis, degenerative), citing “slight” pain, not requiring daily narcotic therapy.  The VA rated the same hip condition at 0% utilizing code 5255 (femur impairment) and separately determined the partial muscle tear was “Not Service Connected”; both based upon the STR.  

Although there was insufficient limitation of motion to support a minimum rating under thigh or hip ROM codes, the  panel agreed that a 10% rating was justified for the continued presence of painful motion IAW VASRD §4.59 as reported on numerous clinical encounters.  In the absence of bony ankylosis or mal-union/non-union, no higher rating was justified.  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 condition.  

BOARD FINDINGS:  In the matter of the left hip condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

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

AR20170008707, 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,