RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02528
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reserve O3, Quartermaster Officer, medically separated for “chronic left hip pain” with a disability rating of 10%.

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 - 20060123	VARD - 20060823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain	5009-5003	10%	Left Hip Strain with Osteoarthritis	5010	10%	20060629	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 November 2003, without specific trauma.  Magnetic resonance imaging on 24 May 2005 showed osteoarthritis of the left hip.  Testing for thyroid disease and connective tissue disorders were negative.  The lumbar spine was evaluated by computed tomography 28 June 2005 and there was no evidence of nerve impingement causing hip pain.  

The 20 December 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant left hip pain aggravated by impact activities, prolonged sitting, and sit-ups.  Physical examination showed tenderness to deep palpation of the left hip.  Hip range of motion (ROM), after three repetitions, showed a flexion of 95 degrees (normal 125) extension of 12 degrees (normal 20 degrees), abduction of 20 degrees (normal 45 degrees) and external rotation of 22 degrees (normal 45).  There was pain with internal and external rotation of the hip.  Lower extremity strength, sensation, and reflexes were normal.   

At the 29 June 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported intermittent left hip pain with stiffness, but no weakness.  The hip pain was aggravated by prolonged sitting.  There were no flare-ups.  The CI was not using an assistive device for walking.   Physical examination showed a normal gait.  Left hip ROM measurements showed a flexion of 100 degrees, extension of 30 degrees, abduction of 30 degrees, and external rotation of 50 degrees.  There was mild pain with abduction.  There was no additional loss of ROM with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left hip pain condition 10%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA also rated the left hip condition 10%, coded 5010 (traumatic arthritis), citing painful and limited motion of a major joint.  

There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 the respective codes.  There was therefore no route to a rating higher than the 10% adjudicated by the PEB under any applicable VASRD §4.71a code.  

The panel noted that the PEB’s reliance on the USAPDA pain policy did not prevent arriving at the highest rating and a 10% rating is also supported under 5003 in compliance with the VASRD for imaging evidence of arthritis with painful or limited motion.  Therefore, no change to the PEB’s coding choice is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left hip condition.  

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.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20150702, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013312, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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