RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01447
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20080310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantry, medically separated for “chronic right hip pain secondary to femoral head avascular necrosis” with a disability rating of 10%.

CI CONTENTION:  Service rating was disproportional.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20080230	VARD - 20081218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	10%	Right Hip Dysplasia w/ Avascular Necrosis	5253	20%	20080109	
	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic Right Hip Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s right pain hip condition began in February 2006 while deployed where he denied any trauma at onset.  On 8 June 2007 x-ray evaluation of the right hip demonstrated findings suggestive of right hip dysplasia.  On 27 July 2007 orthopedic evaluation reported right hip pain with difficulty getting out of bed and performing military duties.  Physical examination showed decreased right hip range of motion (ROM) in every direction, exquisite tenderness with abduction, exquisitely painful internal rotation and adduction.  

The MEB Physical Therapy ROM measurements on 19 July 2007, 8 months prior to separation, showed flexion of 95-100 degrees (normal 125), extension to 10 degrees (normal 20),and abduction of 15-20 degrees (normal 0-45).  The examiner noted that there was sufficient hip adduction to cross legs and that ROM was limited by pain.  The 18 September 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of difficulty with standing for long periods of time, walking distances over 200 meters, trouble walking up and downstairs, and pain when going from a prolonged sitting position to movement.  

During the 11 October 2007 civilian orthopedic examination, 5 months prior to separation, the CI complained of right hip pain limiting him from walking more than about a quarter mile at a time.  Physical examination showed a mild Trendelenburg (shifts the torso over the affected hip, thereby reducing the load on the hip and decreasing pain) gait on the right and a positive Trendelenburg sign (indicating that the hip abductors of the involved limb are weak).  The right hip ROM in degrees was flexion 105, external rotation 30-40, and no internal rotation.  There was pain with extension and flexion and 5/5 right lower extremity strength.  

At the 09 January 2008 VA Compensation and Pension (C&P) evaluation, 2 months prior to separation, noted complaints of right hip pain.  ROM measured in degrees was flexion 40 (normal 125), extension 10 (normal 20), and abduction 10 (normal 0-45).  The examiner noted that CI was unable to toe out or cross the right leg over left.  There was right hip tenderness to palpation and pain on motion.  There was no change in ROM with repetition.  The 20 May 2008 VA Orthopedic physical examination, 2 months after separation, showed a right shoe lift, definite Trendelenburg, and antalgic right hip limp.  The examiner noted an adduction deformity, definite thigh atrophy, and markedly limited/very irritable ROM; flexion 90, extension 10, and abduction 0, adduction 20, internal rotation 0, and external rotation 10 degrees. The examiner noted that the right leg was 1 inch short than the left.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5003 (degenerative arthritis), based on the US Army Physical Disability Agency Pain Policy rated for moderate and constant pain.  The VA rated the right hip condition 20%, coded 5253 (thigh, impairment) based on the VA examination 7 months before separation (not in evidence), citing limitation abduction beyond 10 degrees.  Panel members agreed that the evidence of avascular necrosis of the femoral head, persistent daily pain, and an antalgic gait support a 20% rating for moderate hip disability due to impairment of the femoral neck under the 5255 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right hip condition, coded 5255.

BOARD FINDINGS:  In the matter of the chronic right hip pain condition, the panel unanimously recommends a disability rating of 20%, coded 5255 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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 Hip Pain	5255	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180003423, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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