RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02398
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic left hip pain,” with a disability rating of 10%.

CI CONTENTION:  The CI has requested a review of all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20080521	VARD – None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain…	5099-5019	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Left Hip Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip pain condition began in September 2007 insidiously after an increase of physical activity.  The MEB forwarded “left hip pain” for PEB adjudication.  At a primary care clinic appointment on 25 September 2007, the CI reported chronic hip pain exacerbated with standing, running and walking.  He reported a snapping and clicking sensation in the hip.  The pain was described as radiating down the left side without any numbness, bowel or bladder complaints.  The CI was given Ibuprofen and instructions to apply ice to the area of pain.  No physical examination findings were annotated.  The CI returned to the primary care clinic on 7 November 2007, 8 months prior to separation, with reports of left lateral and posterior hip pain.  At a physical therapy appointment on 7 February 2008, 5 months prior to separation, the CI presented with complaints of left anterior hip pain for 2 months that increased with activity (6-8/10), but was also present at rest.  The physical therapist noted that the CI had moderate discomfort on the left with hopping, mild painful Fabre’s at the left anterior hip and full active range of motion (ROM) at the hip with mild pain at the end of the ROM.  A physical therapy appointment on 27 February 2008, 5 months prior to separation, noted the CI’s hip pain went from a pain level of 1/10 prior to treatment to a 2-3/10 after treatment.  The physical therapy treatment employed was stationary bike for 10 minutes, active hip range of motion (AROM), resisted hip abduction/adduction/extension with 20 pound weight, and lateral gait with resistance bands.  The physical therapist noted that the pain was localized in the hip joint.  At an orthopedic examination performed on 25 March 2008, the CI complained of left lateral hip pain.  The CI stated that the pain was exacerbated by lying on her right side and activity.  Physical examination findings showed that the CI had positive pain to palpation over the greater trochanteric region of the left hip.  The physical examination demonstrated mild discomfort with resisted forward flexion, adduction and abduction of the thigh upon the hip area on the left side.  ROM testing showed normal forward flexion, external rotation and internal rotation.  The examiner rendered a diagnosis of left greater trochanteric bursitis.  On 25 March 2008 at an orthopedic clinic appointment, 4 months prior to separation, the CI complained of left hip pain ongoing for 5 months.  The CI stated that the left hip pain was located laterally, exacerbated when lying on her left side and returned with activity.  On 26 May 2008, 2 months prior to separation, a bone scan of the pelvis and hips was reported as negative.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 May 2008, 2 months prior to separation, the CI reported pain in the left hip.  Physical examination showed the CI had a normal walk, heel to toe, jog and jump without pain or grimace.  The examiner noted tenderness to palpation at the left greater trochanteric area.  The MEB NARSUM examination on 12 May 2008, 2 months prior to separation, noted complaints of increased left hip pain with increasing physical activity and training.  Physical examination showed active range of motions at the left hip were normal in flexion, abduction and external rotation and 40 degrees internal rotation.  The examiner found minimal tenderness to palpation at the left lateral greater trochanter.  The examiner noted that there was no limitation of motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left hip pain condition 10%, analogously coded 5019 (bursitis), citing rated as bursitis of the greater trochanter based on clinical findings without abnormal imaging.  A VA claim was not in evidence, therefore no rating or coding by the VA.  The Board noted that there was not any evidence of hip ankylosis, thigh limitation of flexion to 30 degrees, or loss of thigh abduction beyond 10 degrees of motion for a higher rating.  The Board also noted that there was no evidence of nerve involvement.  The Board agreed that a 10% rating, but no higher, was justified for functional loss due to pain with use IAW §4.40 (Functional loss).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left hip pain condition.  

BOARD FINDINGS:  In the matter of the chronic left hip pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150925, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004618, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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