RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00228
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Operator, medically separated for “right hip pain…” with a disability rating of 0%.

CI CONTENTION:  The CI requested a review of 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 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 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 - 20070914	VARD - 20080131	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain…	5099-5003	0%	Right Hip Stress Fracture	5255	0%	20071105	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed right hip pain during basic training in May 2005.  A bone scan demonstrated a stress fracture of the right pubic ramus (pelvic structure supporting the hip socket).  That injury was rehabilitated; follow-up imaging demonstrated healing; and, she completed basic training.  She developed hip pain once again in later training.  A bone scan at that time demonstrated a stress fracture (“healing versus recurrent”) of the proximal right femur (adjacent to the hip joint).  Follow-up imaging (serial X-rays, bone scan, MRI) was normal, but the pain persisted.  There were no surgical indications.

There were STR clinical entries that documented normal or modestly limited range of motion (ROM), without specific annotation of painful motion.  There was STR documentation of normal gait and strength; and, there were no entries that suggested any more significant ROM limitation or functional impairment, and none that documented any additional VASRD-ratable findings

The 14 August 2007 NARSUM examination, 5 months prior to separation, documented “continued right hip pain which she rates as 5/10” exacerbated by “prolonged standing, walking, after prolonged sitting, with repetitive movement of the hip, climbing stairs, squatting, bending, lifting or carrying weight, and with impact activities.”  The physical examination recorded tenderness that was “increased ... with [ROM],” no crepitus, and normal (5/5) strength.  The NARSUM cited goniometric ROM measurements by physical therapy (3 July 2007, 5 weeks earlier).  These were average flexion to 86 degrees (normal 125) average extension to 15 degrees (normal 20), and average abduction to 19 degrees (normal 45).  The PT examiner specified painful motion, and this was reiterated in the NARSUM.

The 5 November 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, documented constant pain rated 9/10 that was “elicited by physical activity” including prolonged standing.  The examiner noted, however, that the CI “continues to work” in her food services specialty.  The physical examination recorded a normal gait and the absence of any positive joint findings (specifying no tenderness, weakness, etc.).  The C&P ROM measurements were normal in all VASRD-ratable planes of motion, and the examiner specified the absence of painful motion or degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip pain condition 0%, coded analogously as 5003 (degenerative arthritis), citing the U. S. Army Physical Disability Agency (USPDA) pain policy and specifically acknowledged “ROM limited by pain.”  The VA also rated the right hip pain condition 0%, coded 5255 (impairment of femur), based on the C&P examination 2 months before separation, citing failure to achieve the minimum 10% criterion for “slight” disability under that code.  

A key issue for the panel’s recommendation in this case was whether or not to concede the criterion of painful motion in support of the minimum compensable 10% rating as specified in VASRD §4.59.  Clearly there was satisfactory evidence of painful motion applicable to the PEB’s adjudication that was circumvented by the USAPDA pain policy, although the VA evidence more temporally probative to separation refuted the presence of painful motion.   Member consensus was that, in fairness, painful motion was reasonably conceded.  Even considering that the VA findings were more temporally probative, they were in distinct contrast with the preponderance of the evidence.  

Furthermore, member consensus was that, even if painful motion were not conceded, a 10% rating was justified via analogous application of the VA’s code, i.e., 5299-5255.  The functional impairment in evidence at separation (limitations on walking, standing, sitting and other common activities) could be reasonably characterized as “slight” hip disability; although, members agreed that the “moderate” criterion for the next higher 20% rating was not supported (normal gait and mobility with restrictions confined to more strenuous activities).  There was no ROM limitation or evidence for any other criterion that would support a rating higher than 10% under any applicable code available in VASRD §4.71a.  

After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the right hip condition under code 5099-5010 (analogous to traumatic arthritis, defaulting to criteria of 5003).   

BOARD FINDINGS:  In the matter of the right hip condition, the panel by a majority vote recommends a disability rating of 10%, coded 5099-5010 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Residuals of Stress Fractures, Right Hip 	5099-5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014141, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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