RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00840
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Track Vehicle Repairer, medically separated for “chronic bilateral hip pain” with a disability rating of 0%.   

CI CONTENTION:  “Separation was due to the Army not wanting to perform surgery that was required to repair the injuries to both hips.”  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 - 20041008	VARD - 20041216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain…	5099-5003	0%	Trochanter Bursitis, Right Hip	5252	10%	20041025	
			Trochanter Bursitis, Left Hip	5252	10%	20041025	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  The PEB combined the right and left hip pain conditions under a single disability rating, coded 5099-5003 (analogous to degenerative arthritis) and rated 0% with application of the US Army Physical Disability Agency pain policy and AR 635-40 B24.f.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel noted that “bundling,” the combining of two or more major joints, may be 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.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral hip pain condition began in November 2001 with his left hip after running.  Radiographic studies (X-rays and MRI) were reported as normal.  There was no surgical indication.  The 2 September 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of not being able to lift or carry heavy objects, not being able to squat or kneel down for long periods.  He was having increased pain intimately during intercourse. Physical examination showed tenderness to palpation at the bilateral trochanter.  Painful motion was present with adduction.  Physical examination was able to identify and reproduce popping of both hips.  Range of motion (ROM) measurements of the right hip were extension 15 degrees (normal 20); flexion 90 degrees, (normal 125) adduction 30 degrees (normal 25), abduction 30 degrees (normal 45) and external rotation 40 degrees (normal 60).  ROM measurements of the left hip were extension 15 degrees,  flexion 100 degrees; adduction 10 degrees; abduction 45 degrees and external rotation 30 degrees. 

At the 25 October 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant popping, pain, and tenderness in both hips.  It was difficult to lift things or walk without pam.  Physical examination showed a normal gait.  ROM measurements of the right hip were extension was 30 degrees (normal 20); flexion 125 degrees, adduction 25 degrees, abduction 45 degrees and external rotation 60 degrees.  ROM measurements of the left hip were extension 30 degrees, flexion 125 degrees; adduction 25 degrees; abduction 45 degrees and external rotation 60 degrees. On the right, ROM was additionally limited by pain and pain was the major functional impact.  ROM on the right was not additionally limited by fatigue, weakness, lack of endurance and incoordination.  On the left, ROM was additionally limited by pain and pain was the major functional impact.  ROM on the left was not additionally limited by fatigue, weakness, lack of endurance and incoordination.  Painful motion was present for both the right and left hips.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip pain condition 0%, coded as 5099-5003 (analogous to, degenerative arthritis), citing range of motion within normal limits, not requiring narcotics and  the US Army Physical Disability Agency pain policy.  The VA rated the bilateral hip pain condition 10% for each hip (right 10% and left 10%), coded 5252, (limitation of flexion of thigh), based on the C&P examination 1 month before separation, citing painful motion.  The panel first considered if the right and left hip conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The commander’s statement, profile and other STR evidence did not provide sufficient information which would permit the panel to discriminate the performance limitations attributable to either hip over the other.  Since undue speculation would be required to conclude that impairment from either hip would not have unacceptably interfered with MOS performance, members agreed that each hip was reasonably justified as separately unfitting.  The panel agreed that there was insufficient limitation of range of motion in either hip to provide a minimum rating using VASRD codes 5251 (thigh, limitation of extension of), 5252 (thigh, limitation of flexion of) or 5253 (thigh, impairment of).  In addition, there was no indication of a flail joint of the hip to support an 80% rating using code 5254, ankylosing of the hip to support a 60% rating using code 5250 or malunion of a femur fracture to support a 10% or higher rating using code 5255.  There was evidence of painful motion (VASRD §4.59) to support a minimum 10% rating using code 5253 due to painful adduction of each hip.  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 right hip condition, coded 5253 and a disability rating of 10% for the left hip condition, coded 5253.  

BOARD FINDINGS:  In the matter of the right hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5253 IAW VASRD §4.71a.  In the matter of the left hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5253 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	
Right Hip Pain	5253	10%	
Left Hip Pain	5253	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018018, 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