RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00031
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated for “chronic pain, right hip, status post-operative treatment acetabular fracture” and “chronic back pain, status post fracture of left T12 rib at costovertebral junction,” rated at 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “VA rated my unfitting disability at 30% immediately after my separation in 2004.  Also, my spine fracture was rated at 10%, warranting medical retirement.”  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 - 20040405	VARD - 20040802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Hip…	5099-5003	10%	Open Reduction Internal Fixation, Complex Right Posterior Wall Acetabular Fracture Nonunion with Iliac Crest Bone Grafting	5255	30%	STR	
Chronic Back Pain… 	5235	10%	Residuals of Thoracic Fracture with Back Pain	5235	10%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in April 2003 after a helicopter’s wheels were lowered onto his back and pelvis in an accident while deployed.  A pelvic CT revealed a right, posterior wall acetabular fracture and he underwent hip surgery with open reduction internal fixation of the fracture on 12 August 2003.   

At the 28 October 2003 orthopedic clinic evaluation, 7 months before separation, the CI reported continued pain.  Physical examination showed right hip range of motion (ROM) of 85 degrees (normal 125) flexion, 20 degrees (normal 45) external rotation, and 5 degrees (normal 45) internal rotation. During a follow-up orthopedic visit on 9 December 2003, the CI was still experiencing pain.  Physical examination revealed right hip ROM of 85 degrees flexion, 35 degrees external rotation, and 15 degrees internal rotation.  At the 10 February 2004 primary care appointment, 3 months before separation, the CI had no specific complaints.  Physical examination showed right hip ROM of 85 degrees flexion, 35 degrees external rotation, and 15 degrees internal rotation.  

The 23 February 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of moderate to severe pain that caused difficulty with sleeping, and sitting or standing for prolonged periods.  Physical examination revealed a right hip ROM of 90 degrees flexion with pain, 25 degrees (normal 45) abduction, 30 degrees external rotation, and 20 degrees internal rotation.  The CI had pain with passive right hip ROM.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right hip condition 30%, coded 5255 (femur, impairment of), based on the STR, citing malunion of the femur with marked knee or hip disability.  Members agreed there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5251 or 5252).  There was no limitation of abduction, adduction, or rotation that supported a rating under the VASRD diagnostic codes for limitation of motion (5253).  There was no hip flail joint that supported a rating under the VASRD diagnostic code (5254).  There was no impairment of the left femur with fracture of shaft or anatomical neck with nonunion; or fracture of the surgical neck with a false joint; or malunion with slight knee or hip disability to justify a rating under 5255 (femur, impairment of).  There was, however, evidence of painful motion of the right hip with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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.  

Chronic Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition also began in April 2003 after the helicopter landing accident.  A thoracic spine CT showed an avulsed fracture fragment of the left T12 rib next to the rib vertebra junction.  During MEB examination the CI reported pain rated at 2-3/10 at rest and 6-7/10 with activity.  Physical examination revealed tenderness in the L5-S1 area.  On the same day, the MEB NARSUM examination noted complaints of moderate to severe pain affecting sleep and the ability to sit or stand for any long periods of time.  ROM measurements showed 85 degrees (90 normal) flexion, 35 degrees (30 normal) extension, 30 degrees (normal) right lateral flexion, 35 degrees left lateral flexion, and 65 degrees (normal 30) right and left rotation for a combined ROM of 235 degrees (normal 240).  Painful motion was not mentioned. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5235 (vertebral fracture or dislocation), citing no neurologic abnormality, combined ROM of 300 degrees, and localized tenderness.  The VA also rated the back condition 10%, coded 5235 (vertebral fracture or dislocation), based on the STR, citing painful limitation of motion.  Members agreed there was no evidence to support a rating higher than the 10% adjudicated by the PEB because flexion was not limited to 60 degrees or less; and/or combined ROM was not limited to 120 degrees or less; and/or there was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 back condition.  

BOARD FINDINGS:  In the matter of the chronic right hip pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel unanimously 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 20161222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003335, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure