RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01762
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20021017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Traffic Management Coordinator, medically separated for “degenerative joint disease, bilateral hips” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20020905	VARD - 20030321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Joint Disease, Bilateral Hips	5003	20%	Degenerative Joint Disease, Right Hip	5003	10%	20030220	
			Degenerative Joint Disease, Left Hip	5003	10%		
Fibromyalgia	Not Unfitting	Fibromyalgia	5025	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Degenerative Joint Disease (DJD), Bilateral Hips.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition started in the left hip in 1997 after physical training and in the right hip in 1999.  Initial X-rays were without abnormality.  Treatment remained conservative and included restrictions, medication, and physical therapy.  Follow-up X-rays in 2002 revealed minimal DJD changes in both hips.
At the MEB NARSUM examination on 28 June 2002, 4 months before separation, the CI’s reported continued hip pain.  Physical examination revealed bilateral range of motion (ROM) of extension at 15 degrees (normal 20) and adduction at 35 degrees (normal 45) with painful motion.  Surrounding strength and sensation was normal.  Diagnosis remained bilateral hip DJD.

At the 20 February 2003 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported bilateral hip pain aggravated by prolonged sitting or standing.  She reported her functional loss due to hip pain was the loss of running.  Physical examination revealed an unimpaired gait and full bilateral hip ROM.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain condition 20%, coded 5003 (degenerative arthritis).  The VA rated each hip condition 10%, also coded 5003, based on the C&P examination 4 months after separation, citing intermittent pain with increased pain on sitting or standing for more than 20 to 30 minutes.

The panel first considered whether each painful hip condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  Although initial evidence indicated that the left hip was more pathologically involved than the right, the objective clinical and radiologic evidence more proximate to the date of separation remained essentially equivocal to both hips without significant indication of either side being more impaired than the other.  Panel members agreed to liberally invoke VASRD §4.3 (reasonable doubt) and concede in favor of the CI that the persistent hip pain with activities such as running and prolonged sitting/standing rose to the level that each hip, as an isolated condition, would have rendered the CI incapable of continued military duties; and, accordingly recommends separate ratings for the right and left hip.

Although separately unfitting, panels members agreed there was insufficient limitation of motion to support a minimum rating, the panel further agreed a 10% rating was justified for the presence of painful motion §4.59 (painful motion) for each hip as noted on the MEB NARSUM examination.  However, this rating recommendation provides no additional benefit to the current bundled condition as adjudicate by the PEB at 20%.  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 bilateral hip condition.

Contended PEB Condition:  Fibromyalgia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the contended condition 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 the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the degenerative joint disease, bilateral hips condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended fibromyalgia condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were 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 20150703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008799, 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