RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02345
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Fuel Handler, medically separated for “chronic left hip pain” with a disability rating of 0%.  

CI CONTENTION:  “Review of 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 - 20040618	VARD - 20141222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain 	5019	0%	Left Hip Femoral Neck Fracture/Hip Bursitis w/Femoral Neck Dysplasia 
	5019-5254	NSC	20141009	
Left Proximal Femoral Dysplasia	Not Unfitting 					
Resolved Left femoral Neck Stress Fracture						
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic left hip pain condition began in August 1999 during advanced individual training, without specific trauma.  The CI was diagnosed initially with a proximal femoral stress fracture.  A bone lesion below the trochanter of the left femur was noted and confirmed to be benign on serial magnetic resonance imaging (MRI) in December 1999 and August 2002.  The lesion was thought to be fibrous dysplasia which can be associated with pain or fractures.  An orthopedic follow-up visit on 30 August 2002 indicated the recent MRI showed no evidence of a persistent or recurrent stress fracture, but on examination there was tenderness over the greater trochanter of the hip and the examiner thought there may be bursitis present.  The CI was given an injection for hip bursitis.  At an orthopedic evaluation on 7 April 2004 the CI reported left hip pain and the examination showed hip range of motion (ROM) in degrees of flexion 120 (normal 125), extension 30 (normal 20), abduction 50 (normal 45) and external rotation 40 (normal 45).  There was tenderness of the greater trochanter, but no pain with motion.  

The 14 April 2004 commander’s statement, 3 months prior to separation, noted the CI’s history of a left femoral stress fracture and implicated left hip pain as impairing the CI’s successful performance of her duties.  The 4 May 2004 permanent profile, 3 months prior to separation, listed left hip pain.  

During the 6 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the physical examination showed full ROM with tenderness of the lateral aspect of the left hip.  

The 23 April 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of left hip pain with impact activity or standing for prolonged periods of time.  The MEB NARSUM cited the findings of the MEB DD Form 2808 examination reviewed above.  

The initial VA Compensation and Pension evaluation was performed more than 9 years after separation and is too remote from the date of separation to have probative value for the panel’s rating recommendation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left hip pain condition 0%, coded 5019 (bursitis), citing bursitis without loss of joint motion.  The VA did not originally service connect the left hip condition, but the VARD dated 27 March 2015 service connected the left hip condition, rated 10%, coded 5019-5253 (bursitis-thigh impairment), based on the VA examination more than 9 years after separation and cited inability to toe out more than 15 degrees on the left, with painful motion.  

As noted above the VA evidence is too remote from the date of separation to have any probative value for the panel’s rating recommendation.  The panel’s rating recommendation is based on the findings of the April 2004 orthopedic evaluation and the MEB NARSUM examination.  There was evidence of bursitis and imaging evidence of a benign bone lesion in the region of the CI’s pain which likely contributed to the CI’s persistent proximal femoral pain despite healing of the stress fracture.  However, there was no objective evidence of limitation of motion such as painful motion, swelling, or muscle spasm for 10% rating for an individual joint under the 5003 or related 5019 codes.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of thigh extension, flexion, or thigh impairment (5251, 5252, and 5253).  There was no evidence of hip ankyloses, flail hip joint, or femur impairment (5250, 5254, 5255) for a rating under these respective codes.  There was therefore no rating higher than the 0% adjudicated by the PEB under any applicable VASRD §4.71a code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic left hip pain condition.  

Contended PEB Conditions:  Left Proximal Femoral Fibrous Dysplasia and Resolved Left Femoral Neck Stress Fracture.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  In this case the PEB adjudicated left hip pain as unfitting.  The femoral stress fracture had resolved as noted in August 2002 and the MEB NARSUM examiner determined the resolved left femoral stress fracture met retention standards.  As noted under the discussion of the left hip pain condition, the left proximal femoral fibrous dysplasia condition may have contributed to the development of the left hip bursitis and the MEB NARSUM examiner determined both of these conditions did not meet retention standards.  There was no additional impairment due to the left hip fibrous dysplasia identified in this case other than hip pain and the therefore the condition cannot be considered separately unfitting when considered apart from chronic left hip pain.  Additionally, any contribution to left hip pain attributable to the benign fibrous dysplasia lesion cannot be separately rated IAW VASRD 4.14 (avoidance of pyramiding) and is subsumed in the panel’s rating recommendation above.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left hip pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left proximal femoral fibrous dysplasia and resolved left femoral neck stress fracture conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150909, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011091, 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.

A copy of this decision has been provided to the counsel you listed on your application, Disable American Veterans (DAV), 444 West Fort Street, Room 143, Boise, ID 83702-4535.

Sincerely,