RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01591
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040630

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

CI CONTENTION:  “Review all conditions.”  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 - 20040323	VARD - 20050610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5019	0%	Right Trochanteric Bursitis	5260-5019	10%	20030930
20031021	
Hypothyroidism	Not Unfitting	Hypothyroidism	7903	10%	20031021	
Biopsy, Benign Thyroid Nodule	Not Unfitting	No VA Placement	
Fibromyalgia	Not Unfitting	Fibromyalgia	5025	40%	20031021	
Bilateral Wrist Pain, Carpal Tunnel Syndrome	Not Unfitting					
Adjustment, Mood Disorder	Not Unfitting	Adjustment Disorder…	9435	30%	20030925	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic Right Hip Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in August 1992 during advanced individual training.  She had a long history of repeated right hip pain due to some falls, but also aggravated during increased field duties and heavy lifting.  She was treated with physical therapy and multiple steroid injections throughout 2001.  In April 2002, she underwent a bursectomy, but continued to have chronic right hip pain.  Magnetic resonance imaging of the right hip on 8 January 2003 was normal.  

A 23 February 2003 orthopedic evaluation noted a well-healed scar over the right hip in the area of the bursectomy.  Hip range of motion (ROM) was forward flexion of 110 degrees (normal 125) and external rotation of 45 degrees (normal 45), with pain at the extremes of external rotation.  A second orthopedic evaluation on 12 May 2003 indicated the CI’s pelvis was stable.  There was no evidence of hip/pelvis fractures or soft tissue abnormalities on imaging.  Physical examination showed hip flexion of 110 degrees, external rotation of 45 degrees and internal rotation of 20 degrees (normal 45), with pain at the extremes of both internal and external rotation.  During the 23 May 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 13 months prior to separation, physical examination showed hip flexion of 110 degrees, internal rotation of 35 degrees, external rotation of 40 degrees and painful ROM at endpoints in all planes.

The 30 September 2003 VA Compensation and Pension (C&P) evaluation, 9 months before separation, was also the MEB examination.  The CI reported hip tenderness for 30 minutes each morning and pain that limited her walking to two miles.  Physical examination revealed a smooth, non-tender hip scar (the VA examiner appeared to have reversed left and right on the hip examinations, with the left hip having a scar and tenderness with ROM, and the right hip referred to as “without discomfort.” Noting this was an obvious clerical error, the examination is subsequently referenced for the affected right hip.)  Hip ROM was flexion of 110 degrees, internal rotation of 35 degrees and external rotation of 45 degrees with “some tenderness” at the extremes of internal and external rotation.  Hip X-rays on 5 December 2002 showed no bony abnormalities or diastasis (widening of the cartilage connection between the left and right pubic bones).  Bone scans on 17 December 2002 and 8 January 2003 were also normal.  The 20 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic right hip pain and cited examination findings from the 30 September 2003 C&P/MEB examination

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip pain condition 0%, analogously coded 5099-5019 (bursitis) and the VA rated the right hip condition 10%, analogously coded 5260-5019 (leg, limitation of leg flexion-bursitis), with both ratings based on the C&P examination 9 months before separation.  The PEB cited bursitis without loss of joint motion, and the VA cited the findings of the orthopedic evaluation in May 2003 which showed painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of thigh flexion or extension, thigh impairment (5251, 5252, 5253).  However, members agreed there was evidence of painful, limited hip motion for a 10% rating under 5019.  The examinations proximate to separation did not demonstrate the presence of hip ankyloses, flail hip joint, of femur impairment (5250,5254, 5255) for a rating under the respective codes.  There was therefore no route to a rating higher than 10% under any applicable VASRD §4.71a code.  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 5099-5019.  

Contended PEB Conditions:  Hypothyroidism, Biopsy (Benign Thyroid Nodule), Fibromyalgia, Bilateral Wrist Pain (Carpal Tunnel Syndrome), and Adjustment/Mood Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were implicated in the commander’s statement or judged to fail retention standards.  None were profiled, except for the bilateral wrist pain, which according to the NARSUM, was given a permanent U2 profile (18 March 1998, 6 April 99, and 1 August 2000).  However a “2” profile indicates a condition which requires some physical limitations, but is not necessarily disqualifying for continued military service.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right hip pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5019 IAW VASRD §4.71a.  In the matter of the contended hypothyroidism, biopsy (benign thyroid nodule), fibromyalgia, bilateral wrist pain (carpal tunnel syndrome), and adjustment/mood disorder conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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	5099-5019	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161025, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001884, 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