RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01702
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20040421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Hull Technician, medically separated for “right hip/buttocks pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20040105	VARD - 20050927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip/Buttocks Pain	5299-5003	10%	Residuals Contusion, Right Hamstring Muscle Group XIII with Complex Regional Pain Syndrome	5313-8726	20%	20050421	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Hip/Buttocks Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in November 2000 after falling from a ladder and landing on his right lower extremity and buttock.  Since that time he had complained of persistent right buttocks pain and occasional numbness down his right leg.  His symptoms were aggravated with activities.  He was extensively evaluated by multiple specialties, including orthopedics, physical medicine and rehabilitation, sports medicine, physical therapy, neurosurgery, and pain management.  Due to the lack of any objective findings despite his extensive medical workup, in additional to minimal if any improvement of symptoms with exhausting various treatment options, a MEB was dictated in June 2002 with a diagnosis of right hip and buttocks pain of unknown etiology and chronic right ischial bursitis.  The initial disposition of the PEB on 29 August 2002 was unfit with a combined disability rating of 10%.  The PEB received a request from the CI for reconsideration of the unfit finding.  In addition the PEB received an addendum dictated by a physician in September 2002 requesting an extension of his limited duty in order to allow for further treatment options.  The PEB terminated the original case and allowed the CI to continue on active duty. He was given an additional 8 months of limited duty which expired 22 June 2003.  During this extended limited duty period, the CI continued with his physical therapy program, in addition to receiving three steroid injections, without any significant improvement in his symptoms.  

On 23 April 2003, 12 months prior to separation, the CI presented to the family practice clinic for follow-up of right ischial bursitis.  Physical examination showed full range of motion (ROM) of the hip and lower extremity.  The physician’s assessment was chronic ischial bursitis.  The 12 May 2003 physical therapy clinic visit, 11 months prior to separation, noted complaints of right thigh pain.  Physical examination showed full ROM for the hip and knee.  There was tenderness at the insertion to the ischial bursa.  The examiner’s assessment was scar tissue at the location of the initial injury at the ischial bursa.  

The 25 August 2003 MEB NARSUM examination, 8 months prior to separation, noted complaints of constant buttock pain.  Physical examination showed point tenderness on the right side of the ischial tuberosity.  There was a small indentation in the region of the right ischial tuberosity.  Motor strength was 5/5.  Sensory examination was intact.  Straight leg raising test was negative.  Bone scan, lumbar MRI, and pelvic MRI were normal.  EMG was within normal limits.  

At the 21 April 2005 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported right hip buttock pain.  Physical examination showed the CI walked with a slight antalgic limp.  ROM of the right hip revealed flexion of 125 degrees (normal), abduction 45 degrees (normal), and extension of 30 degrees (normal 20).  Strength was normal.  Tenderness was noted.  A 19 April 2005 X-ray study showed a “small bone island in the head of the right femur.  Otherwise, essentially a negative study.”  

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).  The VA rated the right hip condition 20%, coded 5313-8726, (pelvic girdle and thigh, group XIII muscle function; femoral nerve neuralgia), based on the C&P examination, citing pain with movement of the right leg with associated neurological symptoms.  There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no compensable ROM impairment under the 5251 (limitation of extension), 5252 (limitation of flexion), or 5253 (thigh, impairment) VASRD codes.  There is no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right hip condition.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

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 Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC

							XXXXXXXXXXXXXXXXXX
	     				                        Acting