RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00154
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “bilateral hip pain…” rated 0%.

CI CONTENTION:  “Change in family status (birth of two children), chronic documented hip, (patella femoral) knee and back pain.”  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 - 20030910	VARD - 20031203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain….stress fractures.	5099-5003	0%	Left Hip Stress Reaction	5299-5252	0%	20030919	
			Right Hip Stress Reaction	5299-5252	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain and Chronic Shin Splints.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip condition began after basic training.  During basic training she had a stress fracture in the left tibia area, diagnosed in May 2002.  She was placed on convalescent leave for 30 days in the month of July 2002.  She was also placed on crutches for 6 weeks after the diagnosis of the stress fracture.  The CI was placed in AIT in the month of August 2002, and there she noted right trochanteric pain with stair climbing and increased walking.  She had a bone scan in Early August 2002 that showed persistent shin splints and right more than left hip stress reactions.  Repeat bone scan in January 2003 showed mild stress reactions in both hip joints and mild bilateral shin splints, which were more prominent in the left tibia.

At the 23 April 2003 MEB NARSUM, 6 months before separation, the CI complained that she was unable to perform MOS and soldier duties.  She had pain in both hips at rest that increased with activity.  Pain radiated to the buttocks, thigh, pelvis joints, and back.  She noted occasional numbness sensation and tingling in the low back, which resolves with dangling or shaking her leg.  

Physical examination showed symmetry of bilateral lower extremities, and no evidence of atrophy. Sensory examination was normal.  There was tenderness to palpation over the entire right hip muscle groups and joints.  Hip weakness was not documented; however, there was increased pain and decreased effort with hip flexion, knee extension, inversion and eversion of the foot.  ROM recorded right and left hip flexion to 125 degrees (normal) and extension to 30 degrees (normal).  All other measurements were normal, and pain limiting motion was not recorded.  The examiner diagnosed persistent bilateral hip stress reactions, residual from left tibia stress fracture.  

During the MEB examination (recorded on DD Form 2808, 2807) dated 28 May 2003, 5 months before separation, the CI reported she had bursitis in her hips, which was painful.  She reported she had stress reactions in both hips, and had daily pain with increased walking or stair climbing.  The CI also noted she had stress fracture of the left tibia that had healed but remained tender.

Physical examination recorded tenderness to palpation of bilateral hips, and full range of motion (ROM).  The shin splints or left tibia condition was not documented.

The VA Compensation and Pension (C&P) examination, dated 19 September 2003, 10 days after separation, noted the complaint of “persistent bilateral hip stress reactions, radiating to low back.”  The CI reported that she lifts weight actively.  She noted she was not taking any medication, and that she had intermittent pain in both her hips.  The CI also indicated that she was surprised about the January 2003 lower legs finding of stress fractures (shin splints) as she had been asymptomatic and remained such.

Physical examination noted the CI was in no apparent distress and had a normal gait.  The review of systems noted that she was capable of sustaining heavy physical activities without immediate distress.  The focused hip examination recorded full ROM bilateral hips and lower back.  The examiner stated, “In fact, the veteran is able to place her entire palm on the floor.”  She had normal motor and sensory functions, and was able to walk on her toes, her heels and tandem walk.  She did report pain in her right hip during toe, heel and tandem walk.  The examiner stated, “Patient can undertake the usual activities of daily life and indeed lift weights, walks 2 miles a day and frequently plays racquetball.”  There were no clinical abnormalities in the evaluation of the bilateral legs.  The examiner stated, “There is no functional impairment noted on today’s exam.”

The panel directed attention to its rating recommendation based on the above evidence.  
The PEB rated the bilateral hip pain condition 0% (coded analogously 5099-5003, IAW USAPDA pain policy for pain constant and slight. However, the PEB stated, “In light of non-use of pain medications, pain is judged to be minimal and, at the most, frequent.” The PEB also noted the rating included the diagnosis of chronic shin splints.  The VA separated each hip for 0% rating each, coded, 5299-5252 (myositis).  The VA also assigned a 0% rating for each leg (shin splints) and coded the condition 5399-5312 (muscle group XII).

Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 the panel must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for service rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  

Commander’s statement (CS), was written 6 months before separation, and documented that the CI was probably unable to complete a force road march of several miles with field equipment.  It noted that the CI’s duties required her to lift on an occasional basis, a maximum of 100 pounds with frequent or constant lifting of 50 pounds.  The CS did not attribute the CI’s inability to perform her duties to any specific condition.  The C&P examination, 10 days after separation, noted the CI was actively lifting weights, playing racquetball, and walking 2 miles a day.  She had intermittent hip pain.  The examiner stated the CI had no functional impairment from any of these conditions (hip, shin splints).

The panel proceeded to the rating of the right hip condition.  The panel noted a pattern of improvement over time.  The NARSUM exam, 6 months before separation, noted that the CI had full ROM, but her pain increased with motion; however, did not limit the motion.  The MEB physical examination recorded mild tenderness to palpation of the hip joint and full ROM.  The C&P exam recorded full ROM.  Painful motion was not recorded, nor was there evidence of functional loss.  There was no radiographic evidence of degenerative joint disease. The panel agreed that the preponderance of evidence did not support a compensable rating under code 5003 or any other applicable VASRD code at the time of separation.  .  

The panel next proceeded in rating of the left hip condition.  The panel noted the absence of left hip findings.    ROM was full during the NARSUM and C&P exams.  There was no documentation of pain on motion, limitation of motion, or functional loss.  There was no radiographic findings of degenerative joint disease.

After deliberation, the panel concluded the record in evidence did not support the minimal compensable rating for left hip pain condition under any coding scheme.  The panel agreed neither the left hip nor the right hip condition rose to a level of compensability under §4.59, §4.45 or §4.40.  

The panel next considered the chronic shin splints of the right femur.  The panel considered the CI’s statement that the condition had been asymptomatic, as well as the absence of clinical report of any symptoms other than tenderness, and the absence of right leg pathology during all of the clinical examinations.  Panel members concluded, there was not sufficient evidence supporting a compensable rating under any VASRD code.

Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB adjudication for the bilateral hip pain, and chronic shin splints conditions.  The panel further noted, there was no additional benefit to the CI when the conditions were unbundled, therefore, the PEB appropriately combined the conditions.

BOARD FINDINGS:  In the matter of the bilateral hip pain and chronic shin splints 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160324, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170014082, 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 letter has been provided to the counsel listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
						      					
Enclosure