RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01947
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Helicopter Repairer Trainee, medically separated for “right hip 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 progression or complications of service-connected conditions after separation.  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 - 20081114	VARD - 20060812	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5399-5314	0%	Sartorius Muscle Strain, Right Hip 	5314-5024	10%	20060404	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Hip Pain.  According to service treatment record (STR) and the medical evaluation board (MEB) narrative summary (NARSUM), the right hip condition began approximately 7 months prior to referral for MEB.  A 28 March 2005 right hip radiographic (X-ray) study was normal.  The 13 April 2005 nuclear medicine bone scan showed left leg stress responses secondary to altered weight bearing (favoring the symptomatic right leg).  

At the time of the 20 May 2005 physical therapy (PT) appointment, the CI complained of intermittent aching right hip pain with ambulation and activity.  The physical examination documented limping on the right.  The right hip examination revealed flexor muscle tenderness.  There was pain with hip motion but range of motion (ROM) was normal.  The bilateral Ober's (assesses tightness or inflammation of iliotibial band) and Ely’s (assesses tightness of rectus femoris or lateral thigh fascia) tests, and right Patrick’s (assesses hip and sacroiliac [SI] joint pathology) test, were positive.  

At the time of the 9 August 2005 orthopedic surgery evaluation, the CI complained of recurring right hip pain.  The right hip examination revealed tenderness from the anterior superior iliac spine (ASIS) to the inguinal region.  There was pain with resistance to hip flexion and pain radiated to the anterior thigh through the medial knee.  The assessment listed suspect sartiorius (ASIS to upper tibia muscle that flexes, adducts, and rotates hip) muscle strain.  

At the time of the 27 September 2005 PT appointment for MEB ROM measurements, there was pain-limited right hip active ROM, with flexion of 98/99/100 degrees (normal 125), extension of 10/10/12 degrees (normal 30), adduction of 17/17/17 degrees (normal 25), abduction of 27/27/27 degrees (normal 45), external rotation of 22/25/25 degrees (normal 60), and internal rotation of 19/18/18 degrees (normal 40).  

At the 11 October 2005 MEB NARSUM, 1 month before separation, the CI complained of recurring right hip pain.  Symptoms were exacerbated by climbing, jumping, marching, running, and heavy lifting.  The CI did not experience significant relief from activity modification, PT, or nonsteroidal anti-inflammatory medication.  He denied low back pain, radicular (nerve root irritation or injury) pain, paresthesias (abnormal sensation, tingling, burning, prickling), or lower extremity weakness.  The physical examination documented a normal gait.  The right hip examination revealed SI joint to inguinal region tenderness with no greater trochanter (proximal lateral femur bony prominence) tenderness.  There was pain on resisted hip flexion producing a pain which radiated from the anterior thigh to the medial knee.  The Trendelenburg (assesses for weak hip abductors) test was negative.  The examiner recounted the findings of the X-rays, bone scan, and normal 28 June 2005 right hip MRI study.  The assessment listed sartiorius muscle strain.  

At the 4 April 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported a history of right hip and groin pain after running long distances as part of his training in the Army.  Symptoms were exacerbated by prolonged sitting and standing and relieved by lying down.  The physical examination documented a normal gait with pain at the terminal range of abduction and adduction.  Pain-limited right hip active ROM measurements showed a flexion of 130 degrees, extension of 25 degrees, adduction of 30 degrees, and abduction of 50 degrees.  The ROM was limited by pain, but not weakness, fatigability, or lack of endurance with repetitive motion.  The bilateral log roll (assesses for hip joint pathology) tests were negative.  Strength, sensation, pulses, and deep tendon reflexes were normal and pathologic reflexes were absent.  The right hip X-rays were normal with no evidence of acute fracture, dislocation, or malalignment.  The assessment listed right hip pain.  The examiner opined “The patient does not appear to have any significant disability from muscle strain to the right lower extremity with no severe limitation and right lower extremity range of motion or function.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5314 code (muscle group XIV) citing right hip pain, possible sartiorius muscle strain, negative imaging findings, no knee instability, vastus medialis obliquus tenderness, and hip flexion reproduced pain which radiated from the anterior thigh to the medial knee.  The VA assigned a 10% rating under the 5314-5024 codes (muscle group XIV-tenosynovitis), citing right hip pain, sartiorius muscle strain, negative imaging findings, no knee instability, no vastus medialis obliquus tenderness, hip flexion produced pain which radiated from the anterior thigh to the medial knee, ROM, and painful ROM.  

There was no compensable thigh limitation of extension (5251), thigh limitation of flexion (5252), or thigh impairment of abduction, adduction, or rotation (5253) for consideration under the respective codes.  There was no hip ankylosis (5250), hip flail joint (5254), or femur fracture nonunion/malunion (5255) for consideration under the respective codes.  The panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip condition, coded 5399-5314.  

BOARD FINDINGS:  In the matter of the right hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5399-5314 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Hip Pain	5399-5314	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150713, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011058, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure