RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01843
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “right hip pain and thigh pain,” with a disability rating of 0%.

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 - 20041203	VARD - 20050620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain and Thigh Pain	5099-5003	0%	Residuals of Right Femur Shaft Stress Fracture	5299-5255	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Hip Pain and Thigh Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip and thigh condition began in July 2004 after completing a physical endurance event during basic training.  Diagnostic imaging showed a right mid femoral stress fracture.  

At the physical therapy (PT) evaluation dated 27 October 2004, 2 months prior to separation, the CI reported right greater than left femur pain.  Physical examination showed a normal gait with a limp when attempting to jog on treadmill.  Active hip range of motion (ROM) was normal with normal flexibility and muscle strength.  There was slight weakness (4/5) due to pain.  
Special tests documented painful motion (FABERs [flexion, abduction, and external rotation], crossed adduction, Scour’s) and there was tenderness to the right femur with squeezing or twisting.  The assessment indicated that the CI had “lost motivation” and that with a low pain tolerance there was a poor prognosis for return to duty.  There was no surgical indication and the CI was referred for MEB.  

The MEB NARSUM examination on 16 November 2004, 1 month prior to separation, noted complaints of right hip and leg pain aggravated by running and prolonged standing.  Physical examination showed a normal gait.  There was tenderness to palpation to the right inguinal fold and also slight discomfort to the greater trochanter.  The CI had “normal full range of motion as compared to the left side.  Knee exam, ankles and feet are normal.  There is no swelling and no ecchymosis.  Neurovascular status is intact.  Strength and deep tendon reflexes are normal bilaterally.”  Repeat diagnostic imaging on 1 October 2004 continued to show probable stress fracture of the right mid-shaft femur.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hip and thigh condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing normal motion.  The VA also rated the hip and thigh condition 0% coded 5299-5255 (impairment of femur), based on the STR, citing no evidence of a malunion of the femur causing slight knee or hip disability; or thigh limitation of extension to 5 degrees; or thigh limitation of flexion to 45 degrees.  

The panel deliberated on the probative value of the NARSUM versus the PT examinations regarding both timing and reported details.  The PT examination included special testing, and observed limping on use of the treadmill which supported painful motion of the right hip.  The NARSUM examination, 20 days closer to separation, indicated normal hip motion with no mention of painful motion and no mention of repetition, special testing, or the presence (or absence) of painful motion.  

The panel consensus was that the NARSUM examination had the highest probative value for rating at separation.  There was no compensable limitation of hip motion under codes 5250 thru 5253 for the right hip.  There was no objective evidence of painful motion specified in the NARSUM.  The panel adjudged that there was insufficient evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45).  There was insufficient evidence of at least slight knee or hip disability for a 10% rating analogous to code 5255, and therefore there was no avenue to any higher rating than 0% for the right femur stress fracture condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right hip pain and thigh pain condition.  

BOARD FINDINGS:  In the matter of the right hip pain and thigh pain condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification of the rating and did not elect to submit a minority opinion.  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, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009177, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

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