RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01984
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20081124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Postal Clerk, medically separated for “right hip osteoarthritis” and “left hip osteoarthritis,” rated 0% each, respectively with a combined disability rating of 0%.   

CI CONTENTION:  In an attached statement, the CI requested his overall rating be increased.  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 - 20081007	VARD - 20090601	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Osteoarthritis	5003	0%	Degenerative Joint Disease with Healed Avascular Necrosis, Bilateral Hips	5252-5010	NSC	20090521	
Left Hip Osteoarthritis	5003	0%					
History of Juvenile Rheumatoid Arthritis	Cat III	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Left and Right Hip Osteoarthritis.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced juvenile rheumatoid arthritis at approximately 2 years of age.  The CI successfully completed boot camp, but experienced pain in both hips secondary to chronic osteoarthritis.  

The 7 August 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral hip pain with any aggressive activity, including jogging, or running.  Physical examination of the right hip showed range of motion (ROM) flexion of 110 degrees (normal 125) and abduction of 40 degrees (normal 45).  Left hip ROM showed flexion of 120 degrees and abduction of 40 degrees.  Strength and sensation were normal in both hips, and he had no pain with ROM or localized tenderness to palpation in either hip; however, pain was elicited during hip maneuver tests (positive roll and Stinchfield tests) bilateral hips.  Radiographs (X-ray) of each hip showed moderate level of arthritic changes and magnetic resonance imaging (MRI) showed abnormality consistent with osteoarthritic change.  The examiner noted a childhood history of juvenile rheumatoid arthritis, and opined that the hip condition was likely due to a combination of the childhood disease, as well as progression of the juvenile arthritis condition versus the results of the treatment using steroids.

At the 21 May 2009 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported his hip condition caused pain when carrying certain items or when he was on his feet all day.  He denied incapacitating episodes in the last 12 months.  Physical examination showed right hip flexion of 90 degrees and extension of 40 degrees (normal 20), and abduction of 45 degrees, and similar recordings for the left hip.  The examiner noted absence of painful motion or tenderness.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right hip conditions 10% each, but applied a 10% deduction because the conditions existed prior to service (EPTS), resulting in a 0% rating for each hip, both coded 5003 (arthritis, degenerative).  The VA did not service connect either hip, coded 5252-5010 (thigh limitation of flexion – arthritis due to trauma), citing the hips were not worsened beyond natural progression by military service.  

Panel members considered the PEB’s determination that although the CI’s conditions had existed prior to service, the conditions were service aggravated and thus rated; however, a deduction was made.  Panel members noted the absence of the PEB’s rationale for a deduction.  The PEB did not make reference to pre-service rating of the conditions, nor what would have been the rating at entry.  The STR did not demonstrate that the CI obtained a waiver for his condition.  IAW DODI 1332.39, “If the degree of disability at the time of entrance into military service is not ascertainable in terms of the schedule, no deduction will be made.”  Therefore, panel members concluded, the deduction could not be upheld.

The panel proceeded with the rating determination based on the evidence.  The NARSUM examination recorded absence of painful motion in bilateral hips during ROM testing, and normal muscle strength and sensation in both lower extremities.  It was noted that pain was elicited during maneuver testing.  There was decreased ROM bilateral hips.  The VA C&P examination conducted 6 months after separation, demonstrated findings consistent with that of the NARSUM.  A 10% rating under the 5003 code requires limitation of motion (LOM) rated under the appropriate code or in the absence of compensable LOM under any other code, X-ray evidence involvement of two or more major or minor joint groups with evidence of painful motion. Bilateral hip X-ray showed arthritic changes at the moderate level throughout his hip joints, and the MRI showed osteoarthritis changes.  Panel members agreed the 10% disability rating was justified for each hip based on §4.59 and § 4.45.

The higher rating of 20% under the 5003 code requires radiographic evidence of involvement of two or more major or minor joint groups, with occasional incapacitating exacerbations.  The panel noted the threshold was clearly met for X-ray evidence; however, evidence of incapacitating exacerbation was absent.  There was no evidence of any documentation of medical prescription related to the order of quarters, bedrest, etc.  Therefore, there was no justification for a higher rating under the 5003 code for either hip.  The panel also considered the alternate hip or thigh codes 5250 (ankylosis), 5251/5252/5253 (thigh, LOM), and 5254 (flail joint, hip), but was unable to find a path to a higher rating.

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 each hip condition, coded 5003  

Contended PEB Condition:  History of Juvenile Rheumatoid Arthritis.  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, although listed as a diagnosis, had no profile related restrictions, was not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the 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 right hip osteoarthritis condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the left hip osteoarthritis condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the contended history of juvenile rheumatoid arthritis condition, the panel 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Hip Osteoarthritis	5003	10%	
Left Hip Osteoarthritis	5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150717, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 26 Jun 17 XXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 26 Jun 17 XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 20 Jun 17 XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 25 Nov 16 XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 16 Jun 17 XXXXXXXXXXXXXXXXXX
   (g) PDBR ltr dtd 20 Jun 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.     

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months beginning date of discharge with a 50 percent combined disability rating and a final rating thereafter of 20 percent.  

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   
     
3.  Please take action to implement these decisions.

	XXXXXXXXXXXXXXXXXX

	Acting,