RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02500
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, AH-64 Attack Helicopter Repairer, medically separated for “snapping hip syndrome of the left hip,” with a disability rating of 0%.

CI CONTENTION:  The CI 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 - 20070814	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Snapping Hip Syndrome, left Hip	5252	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Snapping Hip Syndrome of the Left Hip.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip condition began after excessive lower body and running activities.  The MEB forwarded “snapping hip syndrome…” for PEB adjudication.  At a physical therapy evaluation performed on 20 February 2007, the CI presented with complaints of chronic increasing pain of the left greater than right hip.  The CI stated running, jumping, prolonged marching, increase in the load of gear and with all activities aggravated the hip pain.  She reported left hip snapping and grinding.  Physical examination demonstrated snapping and grinding on palpation of the hip.  The hip flexor muscles were tender on palpation. There was pain with hip motion and a positive Ober’s test.  Active range of motion (AROM) showed the left hip flexed at 95 degrees, abducted at 20 degrees, externally rotated at 25 degrees, internally rotated at 20 degrees, and externally rotated at 15 degrees.  At an orthopedic appointment on 2 February 2007, the CI complained of left hip pain and “popping” that she could reproduce.  The CI stated that the pain was aggravated by long periods of ambulation and running, and alleviated by avoidance of aggravating factors.  Physical examination findings included left hip palpable and audible snapping with flexion and internal rotation followed by active extension with external rotation.  There was pain elicited with ROMs in flexion greater than 110 degrees, abduction 0 to 45 degrees, external rotation 0 to 60 degrees and internal rotation 0 to 25 degrees.  The orthopedist did not concur with the German examiner’s diagnosis of hip dysplasia.  The MEB NARSUM examination on 6 June 2007, 4 months prior to separation, noted complaints of left hip pain with snapping at the hip.  Physical examination showed the CI ambulated with an antalgic gait.  Range of motion examination demonstrated the left hip flexed to 90 degrees, extended to 0 degrees and limitation of internal and external rotation with snapping and grinding with flexion beyond 80 degrees.  The examiner observed the CI had difficulty sitting for prolonged periods of time secondary to hip pain and was unable to flex the left hip to more than 90 degrees with the knee bent while standing.  The neurological examination of the hip was within normal limits.  There was no VA Compensation and Pension (C&P) evaluation in evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, coded 5252 (thigh, limitation of flexion), citing rotation and snapping with a flexion beyond 80 degrees.  The CI demonstrated on several occasions that she was able to actively demonstrate normal range of motion at the hip; however, there was associated pain with movement, palpable tenderness and audible crepitus.  The CI was observed to ambulate with an antalgic gait.  The snapping hip syndrome was annotated on the CI’s physical profile and mentioned explicitly and descriptively on the commander’s statement as a limiting factor in her abilities to function on a daily basis.  Members agreed the evidence supports a 10% rating for painful motion and functional loss IAW §4.59 (Painful motion) and §4.40 (Functional Loss).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the snapping hip syndrome of the left hip condition, coded 5299-5252.  

BOARD FINDINGS:  In the matter of the snapping hip syndrome condition, the Board unanimously or majority recommends a disability rating of 10% coded 5299-5252.  IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	
Snapping Hip Syndrome, Left Hip	5299-5252	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151030, w/atchs
Exhibit B.  Service Treatment Record

AR20170004630, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

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