RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02547
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060531

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

CI CONTENTION:  The CI’s condition continues to affect daily activities.  Her 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 - 20060409	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	0%	No VA Examination in Evidence	
Plantar Fasciitis	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Hip Pain. The PEB combined the right and left hip conditions under a single service disability rating, coded analogously to 5003 and rated together at 0%. The Board noted that the PEB often combines multiple conditions under a single rating when those conditions considered individually are not separately unfitting and would not cause the member to be referred into the Disability Evaluation System (DES) or be found unfit because of physical disability (DoDI 1332.38, paragraph E3.P3.4.4.; “Overall Effect”).  This approach by the PEB reflects its judgment that the constellation of conditions was unfitting, not a judgment that each condition was independently unfitting.  When combining conditions in this manner, the PEBs concluded that there was no need for separate fitness adjudications.  When considering a separate rating for each condition, the Board first must satisfy the requirement that each unbundled condition was unfitting in and of itself based on a preponderance of evidence.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in August 2002 after running in basic training.  X-rays, bone scan, magnetic resonance imaging (MRI) and arthritis evaluations were negative.  During the January 2006 MEB examination (recorded on DD Forms 2807 and 2808), 10 months prior to separation, the CI reported bilateral hip pain every day.  

The 28 February 2008 MEB NARSUM examination, 1 month prior to separation, noted complaints of bilateral hip pain.  Conservative treatment (physical therapy, non-steroidal medication and chiropractor) did not result in remediation of pain.   She was unable to take the fitness test or work in her military occupational specialty.  Her profile prevented running or sit-ups.  She was going to school and lived with her fiancé.  Physical examination range of motion (ROM) showed right hip flexion 110 (normal 125) and extension 10 (normal 20) and left hip flexion to 105 degrees and extension 10 degrees.  The physical therapist questioned the validity of the ROM measurements “due to the patient’s ability to vary.”  Gait, deformity, swelling and redness were not addressed.  There was no VA Compensation and Pension evaluation in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain condition 0%, coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy which rated the condition as minimal and intermittent.  The Board also noted that “bundling,” the combining of two or more major joints (in this case hips), is permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  In this case, the evidence in the STR indicated both hips were equally symptomatic and together were considered unfitting.  The symptoms and examination findings were essentially the same in both hips.  Under code 5003, when the limitation of motion of the specific joint or joints involved is non-compensable under the appropriate diagnostic codes, a rating of 10% is applied for each such major joint or group of minor joints affected by limitation of motion.  Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.  The Board noted there was no evidence of painful motion or limited motion severe enough to be rated.  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 bilateral hip pain condition.  

BOARD FINDINGS:  In the matter of the bilateral 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 20151116, w/atchs
Exhibit B.  Service Treatment Record

AR20170005414, XXXXXXXXXXXXXXXXXX

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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.

Sincerely,