RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01175
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “chronic right snapping hip syndrome (coxa saltans)” with a disability rating of 0%.

CI CONTENTION:  Additional unfitting conditions were 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 - 20040203	VARD - 20041019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Snapping Hip Syndrome (Coxa Saltans)	5024	0%	Chronic Right Snapping Hip Syndrome, Status Post Arthroscopy	5099-5024	10%	20040806	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right Snapping Hip Syndrome (Coxa Saltans).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in November 2000 during advanced individual training.  No specific injury or trauma was noted.  She was able to continue duty with medications and duty modifications.  After multiple MRI, X-rays and bone scans were performed she was diagnosed with chronic snapping hip syndrome (coxa saltans) and a labral (cartilage lining of the hip joint) tear.  An arthroscopy was performed on 29 July 2003 which showed fraying of the ligamentum teres (a ligament which helps to hold the ball of the hip in the socket) and plica (redundant joint lining) of the hip.  She was rehabilitated in physical therapy with improvement in her range of motion (ROM) post-surgery, but pain persisted.  The MEB NARSUM examination was dated 2 December 2003, 7 months prior to separation, noted complaints of continued right hip pain and a snapping hip despite 3 months of rehabilitation.  She was unable to run, march, or jump.  She used a cane and walking was limited to 30 minutes.  The ROM was reduced and painful in some planes as charted below.  An audible snap was present on flexion and extension of her right hip.  A bone scan on 2 December 2003 was consistent with degenerative changes, but was not consistent with reflex sympathetic dystrophy (disease of the nervous system characterized by chronic-severe pain), which had been a diagnostic concern.  A peripheral neuropathy (weakness, numbness, and pain from nerve damage) was excluded on electro-diagnostic testing on 10 March 2004.

At the VA Compensation and Pension (C&P) evaluation performed on 6 August 2004, 1 month after separation, the CI had a normal gait, but also used a cane.  The ROM was reduced as charted below.  Painful motion was not documented.  X-rays were normal.  The ROM examinations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Hip (Thigh) ROM
(Degrees)	Ortho ~8 Mo. Pre-Sep	MEB ~7 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Flexion (125 Normal)	85	125 (full)	76	
Extension (20)	---	20 (full)	---	
External Rotation (45)	45	45	16	
Abduction (0-45)	---	50	34	
Adduction (45)	---	45 (normal)	16	
Comment		Painful motion	Painful motion not recorded	
§4.71a Rating	10%	10%	10%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5024 (tenosynovitis), citing no loss of joint motion due to mechanical obstruction and no joint disability.  The VA rated the right hip condition 10%, analogously coded 5099-5024 (tenosynovitis), based on the C&P examination 1 months after separation, citing painful or limited motion of a major joint.

The panel agreed there was no limitation of hip motion to support a rating under codes 5251 (limitation of extension), 5252 (limitation of flexion), or 5253 (thigh, impairment).  However, painful, limited motion in the presence of radiographic pathology does support a 10% rating under the code 5024.  There was no femur malunion with knee or hip disability to support a higher rating under code 5255.  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 5024.

BOARD FINDINGS:  In the matter of the right hip condition, the panel unanimously recommends a disability rating of 10%, coded 5024 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 Right Snapping Hip Syndrome (Coxa Saltans)	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018932, 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