RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01847
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050421

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 bilateral hip pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI’s conditions continue to worsen.  The 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 - 20050329	VARD - 20061212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5003	0%	Residuals, Stress Fractures, Femoral Neck, Bilateral	5253	0%	20061106	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 began in December 2004 during the first week of basic training.  There was no surgical indication.  

During the February 2005 MEB examination (recorded on DD Forms 2807 and 2808) 2 months prior to separation, the CI reported pain in both hips.  Physical examination showed bilateral hip pain with full range of motion (ROM).  The 10 March 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of mild, persistent hip pain confined to the hip.  She took pain medication occasionally.  Physical examination showed she was in no acute distress, and there was no apparent deformity of the lower extremities.  There was no tenderness on palpation of the greater trochanter bilaterally.  Right hip ROM testing was recorded as flexion of “past 100 degrees with no pain” (125 normal), “full extension” (20 degrees normal), 45 degrees external rotation (normal), and 30 degrees internal rotation (45 normal).  Left hip ROM was flexion of “past 100 degrees with pain at extreme of flexion” (125 normal), “full extension” (20 degrees normal), 45 degrees external rotation (normal), and 20 degrees internal rotation (45 normal).  Bilateral hip adduction and abduction were not recorded.  

At the 6 November 2006 VA Compensation and Pension (C&P) evaluation, 18 months after separation, the CI reported she took anti-inflammatory medication on an as needed basis for her bilateral hip pain.  Her pain was exacerbated by standing or walking long distances.  Physical examination showed the CI walked with a normal gait and had no limp.  ROM testing revealed normal range of flexion, abduction, and adduction, external and internal rotation in bilateral hip.  She had normal muscle strength bilaterally.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain 0%, coded 5003 (arthritis, degenerative (hypertrophic or osteoarthritis), citing full range of motion and strength of lower extremities.  The VA also rated the bilateral hip pain 0%, coded analogously 5253 (thigh, limitation of flexion of), based on the C&P examination 18 months after separation.  

The approach by the PEB and the VA 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 this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.

Panel members considered the objective findings and associated disability for each hip were identical.  Since there was no limitation of motion, a compensable rating under the 5003 code was not justified.  Likewise, the condition was not compensable IAW VASRD 4.59.  There was no additional applicable code for panel consideration since there was no evidence of ankylosis, limitation of motion, or malunion of the femur bone.  As mentioned above, the panel considered the bundling of the hips was permissible under the VASRD 5003 rating requirements, and, was appropriately used in this situation.  There was no VASRD §4.71a route to a rating higher than the 0% adjudicated by the PEB under any applicable code.  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 pain.  

BOARD FINDINGS:  In the matter of the bilateral hip pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20150623, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170009095, 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