RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00725
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Systems Operator-Analyst, medically separated for “chronic right hip pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for his unfitting condition as well as other conditions not within the panel’s scope.  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 - 20040928	VARD - 20041118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	10%	Trochanteric Bursitis, Right Hip	5299-5252	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began insidiously in April 1999 without a specific injury.  X-rays of the pelvis dated 24 July 2002 were normal, while X-rays of the lumbar spine dated 16 September 2002, ordered for chronic right hip pain secondary to a stress fracture in the ilium, revealed no issues.  A bone scan of the pelvis and lower extremities dated 18 September 2002 was normal.  

Examination on 11 May 2003 revealed mild tenderness of the right greater trochanter with a full range of motion (ROM) of the hips bilaterally and a steady gait.  At an examination on 23 October 2003 the CI had no pain, was able to squat without pain, and could perform other physical maneuvers. The CI was returned to his duty station from deployment after he was given a P3 profile for trochanteric bursitis.  At an orthopedic clinic visit on 6 November 2003 the CI had an arthrocentesis (aspiration of fluid from a joint) injection to the right trochanteric bursa and underwent physical therapy thereafter.  At an orthopedics visit on 24 February 2004, the CI had a full ROM with painful motion on flexion and abduction.  At an orthopedic evaluation on 2 August 2004 the CI had pain with flexion and abduction, but the ROM was full and there was no tenderness or instability of the hips. 

During the August 2004 MEB examinations (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported bursitis of the right hip.  Physical examination showed tenderness of the right greater trochanter.  Testing for hip pathology (Patrick/FABER) was negative.  Straight leg raising (to determine nerve root irritation) was also negative.  The 20 August 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of right hip pain and stiffness with increased weight bearing or activities that required repetitive hip flexion such as stair climbing, bike riding, or running.  Physical examination showed pain was elicited by motion of the right hip, primarily with active flexion and abduction.  There was no swelling, erythema, subluxation, or laxity of the hip.  ROM measurements performed by a physical therapist revealed right hip extension 12 degrees (normal 15), flexion with knee flexed 90 degrees (normal 120), adduction 15 degrees (normal 45), abduction 25 degrees (normal 45), internal rotation 40 degrees (normal 45), and external rotation 40 degrees (normal 45).  The CI was distally neurovascularly intact.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right hip pain condition 10%, coded 5099-5003 (arthritis, degenerative), citing slight loss of motion.  The VA rated the right hip pain condition 10%, coded 5299-5252 (thigh, limitation of flexion of), based on the STR, citing evidence of functional loss due to pain which affected the performance of normal working movements of the right hip, a major joint, with normal excursion, strength, speed, coordination, and endurance.  Members noted there was no hip ankylosis (code 5250), limitation of flexion of the thigh (code 5252), thigh impairment (code 5253), or flail hip (code 5254) to warrant a rating higher than 10%.  While imaging studies indicated the CI had a history of a stress fracture of the ilium, there was no evidence proximate to separation of any femur impairment (code 5255), fracture of the shaft or anatomical neck with nonunion, fracture of the neck with a false joint, or malunion with any knee disability.  There was slight hip disability with a rating of 10% based on trochanteric bursitis, but the 10% rating offers no benefit since the PEB rated the right hip condition 10% based on painful motion.  Therefore, there was no route to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic right hip pain condition.  

BOARD FINDINGS:  In the matter of the chronic right 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.  Therefore, the panel recommends 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001940, XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure