RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01628
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “chronic right hip pain,” with a disability rating of 10%.

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 - 20081114	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5009-5003	10%	No VA Exam in Evidence	
Left Hip Pain	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Right Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in early February 2008 during basic training.  Her initial examination and X-ray were normal and she was thought to have an overuse syndrome which was treated with medications and duty limitations.  One week later, she was seen in follow up and reported that her pain was now bilateral and persisted despite the use of crutches.  A bone scan the next day was normal.  Several days after that she reported the hip pain was resolving and only noted with certain exercises.  She next presented on 23 June 2008 and reported a 10 week history of right hip pain.  She was again treated with medications and duty restrictions.  Her pain persisted and she was evaluated in orthopedics on 28 August 2008.  There, it was noted that the range of motion (ROM) was normal but painful in all planes.  She was referred for an immediate MRI to exclude a stress fracture.  It was normal other than an incidental finding of bilateral ovarian cysts (an unrelated finding).  At follow-up in orthopedics on 25 September 2008, she reported ongoing pain, right > left, at the hip flexors.  The ROM was full and painful motion was not recorded.  It was noted that the FABER (flexion, abduction, external rotation: a test for pathology of the sacroiliac joints, hips, and hip flexors) maneuver elicited pain, but did not record where.  It was noted there were no labral (the cartilage lining of the hip joint) signs.  The hip flexors were tender.  Repeat X-rays of the right hip and pelvis were normal.  The right flexors were tender and the FABER maneuver was positive on the right.  In physical therapy on 1 October 2008, the gait was non-antalgic (abnormal due to pain) and posture normal.  The ROM was full but painful on the right at end range.  The CI was again seen in orthopedics on 9 October 2008 and the examination identical to that done 2 weeks earlier.  Formal ROM measurements were obtained in physical therapy on 29 October 2008 and are charted below.  

The MEB NARSUM was dated 4 November 2008, 2 months prior to separation.  It noted that the CI had continued physical fitness training while in training to avoid being recycled.  On examination, she was noted to have tenderness over the right hip and minimal tenderness over the left.  The gait was abnormal and she had difficulty crossing the right leg over the left due to pain (it was not recorded whether or not she was unable to do it though).  She was diagnosed with bilateral hip pain.  There was no VA examination in evidence proximate to separation.  

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

Bilateral Hip
(Thigh) ROM
(Degrees)	ORTHO ~4 Mo. Pre-Sep	ORTHO ~3 Mo. Pre-Sep	MEB PT ~2 Mo. Pre-Sep	
	Right	Left	Right	Left	Right	Left	
Flexion (125 Normal)	145	145	145	145	96	99	
Extension (20)	30	30	30	30	18	26	
External Rotation (45)	70	70	70	70	--	--	
Abduction (0-45)	--	--	--	--	43	43	
Adduction (45)	--	--	--	--	--	--	
Comment	TTP with hip flexors, pain with FABER	TTP with hip flexors, pain with FABER	Pain was noted but painful motion was not specifically recorded.  There was no change with repetition.	
§4.71a Rating			0%	0%	0%	0%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded analogously to 5003 (degenerative arthritis), citing painful motion.  The left hip was determined to be not unfitting.  No VA rating was performed.  The panel considered the evidence.  The MRI, X-rays, and bone scan were all normal.  The limitation in motion was not compensable other than the inability to cross the right leg (if the CI was in fact not able to do this).  The panel noted that this would more properly be coded 5253 (impairment of the thigh), but that the 10% rating it would support provided no advantage to the CI.  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 chronic right hip pain condition.  

Contended PEB Condition:  Left Hip Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The L3 profile was for bilateral hip pain.  The commander’s statement observed that the CI could not perform her military duty because of her physical profile.  The MEB adjudged bilateral hip pain to fail retention standards.  The physical therapy evaluation on 1 October 2008 noted that the ROM was full.  Painful motion was recorded on the right but not the left.  The FABER was positive on the right, but not the left.  One week later in orthopedics, the ROM was full bilaterally.  At the MEB NARSUM examination, 2 months prior to separation, the examiner noted that the restrictions were from the right hip in that it affected her gait and was noted to cause difficulty crossing her legs (right over left).  Minimal tenderness was present over the left hip and a review of the record shows that it was typically either asymptomatic or less symptomatic that the right.  The panel did not find sufficient performance-based evidence from the record to overturn the PEB adjudication that the condition was not separately unfitting separation.  In addition, the panel noted that the ROM was typically full and the limitations noted on the NARSUM were non-compensable.  The imaging studies were normal and painful motion was not recorded in the examinations proximate to separation.  Even were the left hip found to be unfitting, a compensable rating could not be supported and no benefit would be provided to the CI.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic right hip pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left hip condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, w/atchs
Exhibit B.  Service Treatment Record

AR20170008723 , 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,