RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00757
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic pain, left hip” with a disability rating of 0%.

CI CONTENTION:  An additional unfitting condition was not considered.  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 - 20040225	VARD - 20040324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Hip	5099-5003	0%	Left Hip Pain status post Femoral Neck Fracture and Fixation	5255	10%	20040217	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Pain, Left Hip.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip pain condition began in July 2003 after a 3-mile run.  Also in July 2003 the CI received internal fixation to stabilize a nondisplaced left femoral neck stress fracture.  Post-surgical X-rays revealed hardware in anatomic position and the stress fracture was healing.  The 10 November 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of left hip discomfort while running.  Physical examination showed the CI had a normal gait and a 4cm healed surgical scar.  Goniometric range of motion (ROM) was bilateral flexion to 130 degrees (normal 125); bilateral extension to 25 degrees (normal 20); left external rotation to 45 degrees (normal 45) and the right to 60 degrees; bilateral abduction to 60 degrees (normal 45), and bilateral adduction to 20 degrees (normal 45); painful motion was not addressed.  During the 7 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported trouble with prolonged sitting and running.  Physical examination showed the left hip with “decreased ROM”; no measurements were given.

At the 17 February 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant-sharp left hip pains with incapacitating episodes that occurred several times per month that lasted several days.  Physical examination showed a gait within normal limits.  Left hip ROM was flexion to 80 degrees; extension to 30 degrees; adduction to 20 degrees; abduction to 40 degrees and external rotation to 35 degrees all with painful motion.  Left ROM was additionally limited by pain which had a major functional impact; however, new measurements were not provided.  Left ROM was not additionally limited by fatigue, weakness, lack of endurance and incoordination.  Gross examination of the hip joints and muscles was within normal limits.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy rated as minimal and intermittent.  The VA rated the left hip condition 10%, coded 5255 (femur, impairment), based on the C&P examination 1 month before separation, citing a slight hip disability.

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5251 or 5252).  There was no limitation of abduction, adduction or rotation that supported a rating under the code (5253).  There was no hip flail joint that supported a rating under the code (5254).  There was no impairment of the left femur with fracture of shaft or anatomical neck with nonunion; or fracture of the surgical neck with a false joint; or malunion with slight knee or hip disability to justify a rating under code 5255 (femur, impairment).  However, there was evidence of painful motion of the left hip with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left hip pain condition, coded 5299-5255.

BOARD FINDINGS:  In the matter of the left hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5255 IAW VASRD §4.71a.  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 the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Left Hip	5299-5255	10%	

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 

AR20170017580, 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