RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01503
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040406

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

CI CONTENTION:  No specific contention.  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 (VA), 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 - 20040130	VARD - 20050418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	0%	Right Hip Pain, Chronic	5255	0%	20050228	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in approximately October 2002 while running, with no specific injury or trauma.  In January 2003 she complained of pelvic pain in the right inguinal area for 3 months, which was worse on the right side when she did physical training.  The pain level was 3/10 and sometimes was 7-8/10.  Prior X-rays and a pelvic ultrasound were negative. She was very tender to palpation over the superior pubic ligament and right around the inguinal ligament on the right side. There was pain, but no erythema or swelling.  Treatment consisted of a nonsteroidal anti-inflammatory drug (NSAID).  The examiner’s assessment was a stress fracture of the symphysis pubis or an inguinal ligament tear.  No improvement with physical therapy was initially noted.  A bone scan in April 2003 revealed no scintigraphic evidence of stress fracture with particular attention to the region of the bony pelvis and bilateral femoral necks.  At a physical therapy clinic visit in August 2003 the CI reported her right hip was much better and was only aggravated with sit-ups.  X-rays of the right hip were normal in September 2003.  At an orthopedic clinic appointment in October 2003 she reported pain in the groin area.  On examination she ambulated with a normal reciprocal gait pattern without antalgia.  There was some tenderness to palpation, which was a little bit more so above the inguinal ligament.  She was able to flex to 130 degrees (normal 125), abduct to 45 degrees (normal 45) and internally rotate to 25 degrees and externally rotate to 40 degrees (normal 45).  She had mild discomfort with FABER maneuver (to determine hip pathology), but she pointed to the groin, not her sacroiliac region.  She had no pain on the right with a log roll, but had minimal discomfort with a heel tap.  The examiner reviewed her X-rays, bone scan, and magnetic resonance imaging, which appeared normal.  The examiner noted the CI had right hip pain, chronic, refractory to conservative treatment, which appeared to be coming from her hip flexors, but the etiology was somewhat unclear. He expected she would have gotten better after a period of time and activity limitations.  A family practice clinic note in November 2003 indicated the CI complained of right hip pain.  She had received a steroid injection 1 week earlier for presumed bursitis of the right hip.  Treatment consisted of APAP (acetaminophen, a pain reliever) and Ultram (tramadol, an opioid-like medication).    

The 12 December 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain in the right groin worse with running and lifting greater than 20 pounds.  Physical examination showed a markedly antalgic gait, favoring the right lower extremity.  There was tenderness to palpation right around the inguinal ligament.  No hernia was appreciated.  She flexed her hip up to 130 degrees on the right and 140 degrees on the left.  There was no significant flexion contracture.  Further ranges of motion (ROMs) of the right hip were abduction, external rotation, and internal rotation at 20, 20 and 30 degrees, respectively, with discomfort in all planes.  ROMs of the right hip were abduction, external rotation, and internal rotation at 30, 20 and 30 degrees, respectively.  She had minimal discomfort with a heel tap on the right.  She had minimal pain with stretching of her abductor muscles and had some discomfort on performing an active straight leg raise (to determine nerve root irritation).  During the 16 December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported no current medications and no impaired use of the legs or feet.  Physical examination showed bilateral hip and pelvic brim tenderness.  An antalgic gait was noted and squatting caused increased pain to 6/10.

In January 2004 the CI requested a refill of ibuprofen (an NSAID), which seemed to be helping her pain, but it did not last through the night.  Mobic (meloxicam, an NSAID) was prescribed for a trial basis.  At an outpatient clinic visit on 19 February 2004 the CI discussed the findings and rating of the PEB.  On examination of the right hip ROM was 130 degrees, abduction to approximately 30 degrees, external rotation 30 degrees, and internal rotation 30 degrees with discomfort at the end motion of all planes.  She had minimal discomfort with the FABER maneuver and pointed to the groin as her source of pain.  There was minimal discomfort with a heel tap and was able to perform a straight leg raise.  The examiner’s assessment was right hip pain, chronic, refractory to conservative treatment.  The CI had right hip pain in March 2004 that began while stretching.  She was evaluated in the Emergency Room where she was found to be pregnant.  Treatment consisted of Tylenol (acetaminophen).  

At the 28 February 2005 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported she did not have any difficulty with her right hip condition unless she carried her infant child or if she had to walk for extended periods of time.  Physical examination showed an upright and steady gait.  There was no noticeable limp or antalgic gait and she used no ambulatory aid or brace.  She was able to get on and off the examination table without difficulty, walk on her toes and heels, and perform a full squat.  ROMs of the bilateral hips revealed flexion 0 to 105 degrees, backward extension 0 to 30 degrees (normal 20), abduction 0 to 45 degrees, and adduction 0 to 20 degrees bilaterally (normal 25).  There was moderate tenderness to palpation along the groin but without lymphadenopathy in the inguinal area, and was no decrease in strength or muscular status in the lower extremities bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5099-5003 (arthritis, degenerative) citing pain as moderate and intermittent.  The VA also rated the right hip condition 0%, coded 5255, (impairment of the femur), based on the C&P examination 11 months after separation, citing slightly limited motion with some tenderness.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5251 or 5252).  Furthermore, there was no thigh impairment with limitation of abduction, adduction, or rotation (5253), hip ankylosis (5250), or hip flail joint (5254) and there was no fracture, non-union, or malunion of the femur to support consideration under the respective codes for femur impairment related to the long bone condition (5255).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) using code 5099-5003.  Although the etiology of the CI’s right hip/groin pain was not clear; nevertheless, an examiner considered the etiology to be from the hip flexors.  Therefore, code 5399-5316 ((Group XVI Function: Flexion of hip) offers options of a 0% rating for slight, 10% for moderate, and 30% for severe.  Members felt that a 10% for a moderate disability, and no higher, is not unreasonable; however, use of code 5399-5316 offers no additional benefit to the CI.  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 5099-5003.  

BOARD FINDINGS:  In the matter of the right hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001628, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure