RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01695
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic left sacroiliac and left hip pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20080304	VARD - 20090106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Sacroiliac and Left Hip Pain…	5099-5003	10%	Lower Spine Condition	5299-5237	NSC	STR	
			Left Hip Condition	5299-5251	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Sacroiliac and Left Hip Pain.  The PEB combined the left sacroiliac and hip pain as a single unfitting condition coded analogously to 5003 (degenerative arthritis).  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the left sacroiliac and hip conditions are presented separately, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed bilateral hip pain in the first few weeks of basic training.  This was associated with increased activity, but no specific trauma was noted.  A bone scan on 22 August 2007 was suspicious for an injury of the left sacroiliac joint (SIJ, the joint between the pelvis and spine).  An X-ray of the hips the same day was normal.  In primary care on 29 August 2007, her examination was significant for painful and reduced range of motion (ROM) of the right hip.  She was then referred to physical therapy.  Per the NARSUM, the bone scan was repeated on 24 September 2007 and was normal.  The X-rays of the hips were repeated on 29 September 2007 and were again normal.  She was evaluated in orthopedics on 7 November 2007.  She was noted to have a normal examination of both hips.  Measurements of the ROM in physical therapy on 19 November 2007 were noted to be full and pain free.  

The MEB NARSUM examination was dated 9 January 2008, 6 weeks prior to separation.  It noted that the bilateral hip pain never improved with treatment and that she had constant pain in the left sacroiliac region.  The hip ROM was recorded as normal, although flexion was measured at 120 degrees, 5 degrees less than the VA normal value.  Tenderness was absent and motion was pain free against resistance.  Motor function was normal.  Mild tenderness was present over the left SIJ.  Provocative testing for hip and/or SIJ pathology (FABER maneuver) was negative bilaterally.  It was thought that her symptoms would resolve over time.  The MEB forwarded chronic left sacroiliac and left hip pain with no clinical findings for PEB adjudication.  There was no VA Compensation and Pension evaluation in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left sacroiliac and left hip pain condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing full, but painful, ROM.  The VA did not rate the condition as the CI did not supply the requested information.  The panel considered the evidence.  It first considered if the left SIJ pain and left hip pain were separately unfitting.  The ROM of the hips was cited as normal and pain free (although it was just shy of VA normal values).  Provocative testing was negative.  Other than the initial bone scan, all imaging studies were negative including a follow-up bone scan.  No etiology was made for either condition.  The panel observed that pain is a symptom and tenderness a sign; neither is a diagnosis.  Absent a clear etiology for the pain and without significant clinical findings at separation, the panel did not find sufficient evidence to sever the left SIJ and left hip pain into separately unfitting conditions.  The limitation in flexion of the left hip was non-compensable under the hip code for limitation of flexion (5252) and pain free.  Other codes for limitation in extension, rotation, abduction, or adduction were not supported by the evidence.  The panel found no route to a compensable rating for either condition jointly or separately, but does not recommend a rating lower than that adjudicated by the PEB.  It noted that tenderness would support a 10% rating under the code 5236, sacroiliac injury, but that there was no indication of pathology otherwise with a negative FABER maneuver and a negative bone scan (second) and negative X-rays and so a diagnosis of left SIJ injury is not supported.  Regardless, this would provide no rating 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 left sacroiliac and left hip pain condition.  

BOARD FINDINGS:  In the matter of the chronic left sacroiliac and left 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 20150628, w/atchs
Exhibit B.  Service Treatment Record

	

AR20170008716, 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