RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01805
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Dental Specialist, medically separated for “chronic bilateral hip pain,” rated 10% each,  with a combined 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 - 20090127	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5099-5003	10%	No VA Exam in Evidence	
	5099-5003	10%		
Occasional Lower Back Pain and Knee Pain	Not Unfitting 		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in January 2007 during Advanced Individual Training (AIT) without specific trauma.  Radiographs (X-rays) studies of bilateral hips in August 2007 were “within normal limits,” and she had a normal magnetic resonance imaging (MRI) of the right hip in February 2008.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.

At the 8 December 2008 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported bilateral hip pain, more on the left than right hip.  Physical examination showed painful motion of the hips in all movements, no tenderness to palpation and no limitation in leg crossing maneuver.  
 
The 16 December 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of “my hips hurt all the time now.”  The CI reported that she suffered no particular injury, but her hips became sore after the first 3 mile run during AIT.  She had bilateral hip pain daily that was exacerbated with running, jumping, or stair climbing.  Her pain was relieved by rest.  The CI noted that she was still able to perform within her MOS, but that she was primarily limited to sitting in a chair to assist, and was unable to lift or perform any strenuous activities during physical training.  Physical examination showed that she was non-tender to palpation over “expected greater trochanteric regions,” no apparent atrophy or ankylosis.  Range of motion (ROM) recorded right hip with 110 degrees of flexion (normal 125) with pain, and right hip extension averaging 30 degrees (normal 30) with 2 trials, and abduction of 35 degrees (normal 45).  Left hip ROM recorded 110 degrees of flexion without pain, 20 degrees of extension and 34 degrees of abduction.  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 granted bilateral hip condition at 20% rating to reflect a rating of 10% for each hip, coded analogously 5099-5003 (arthritis, degenerative), citing complaint with “greater trochanteric bursitis secondary to overuse.”  A 10% rating under applicable codes 5019, 5255, 5251, 5252, and 5253 requires demonstration of hip disability, radiographic degenerative changes or limitation of motion.  The panel found no evidence to support a rating under any of these applicable codes.  However, there was evidence of limitation of motion secondary to pain, supporting the PEB’s rating of 10% for each hip based on §4.59.  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 Conditions:  Occasional Lower Back Pain and Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic bilateral hip pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended occasional lower back pain and knee pain conditions, the panel recommends no change from the PEB determinations 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 20150706, w/attachments
Exhibit B.  Service Treatment Record

AR20170009320, 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