RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00876
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Patriot System Repairer, medically separated for “left acetabular stress fracture” with a disability rating of 0%.   

CI CONTENTION:  “The constant pain and discomfort makes work difficult and tedious.  Physical labor is slow and almost impossible.  I cannot sit long periods and stand long periods.  The action of moving up and down is difficult.”  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 progression or complications of service-connected conditions after separation.  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 - 20040325	VARD - 20040816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Acetabular Stress Fracture	5099-5003	0%	Left Obturator Syndrome	5299-5255	10%	20040429	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Acetabular Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left hip/pelvic pain condition had been occurring for “years” but increased greatly in January 2003 without any specific injury or trauma.  Plain film X-rays 14 July 2003 showed an area of dense bone with an area of less dense bone within the neck of the femur concerning for a non-displaced fracture.  A 21 July 2003 bone scan showed no areas of increased or abnormal uptake ruling out a non-displaced or stress fracture.  The CI was already on a permanent no running profile due to knee arthritis and additional therapy did not result in sufficient improvement to allow the CI to complete all duties required of his MOS.  
The 20 February 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of left hip pain that awakened the CI at night.  He was using a cane to assist with walking and stated that without the cane he had a noticeable limp.  Physical examination showed tenderness to palpation over the anterior and lateral regions of the hip.  He was able to flex the hip to 60 degrees (normal 125) and abduct to 50 degrees (normal 45) and there was pain with internal and external rotation.  

At the 29 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported left hip pain, mainly over the left buttocks.  The pain was worse with his wallet pressing against the area, sitting, sit-ups, stairs and running.  Physical examination showed an antalgic gait.  There was full flexion, extension, internal and external rotation, abduction and adduction.  The examiner noted pain with adduction and external rotation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hip/pelvic condition 0%, analogously coded 5003 (arthritis, degenerative), citing pain and reduction in range of motion due to pain alone.  The VA rated the left hip/pelvic condition 10%, analogously coded 5255, (femur, impairment of), citing left pelvic pain.  

The panel agreed that there was insufficient limitation of range of motion 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.  The panel did find that there was sufficient evidence of painful motion (VASRD §4.59) to support a minimum 10% rating using code 5299-5253 (analogous to thigh, impairment of).  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 acetabular stress fracture condition, coded 5299-5253.  

BOARD FINDINGS:  In the matter of the left acetabular stress fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5253 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	
Left Acetabular Stress Fracture	5299-5253	10%	

The following documentary evidence was considered:

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

AR20170017219, 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