RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00506
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Petroleum Supply Specialist, medically separated for “bilateral trochanteric bursitis” with a disability rating of 0%.  

CI CONTENTION:  “Depression, arthritic in both knees, and lower back.  Hip pain still cause little to no movement at time. Migraine severe.  All supporting documents are in VA medical records.”  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 – 20061220 	VARD - 20070427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Trochanteric Bursitis	5019	0%	Right Hip Strain	5255	10%	20060913	
			Left Hip Strain	5255	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Bilateral Trochanteric Bursitis.  The PEB combined the right and left trochanteric bursitis conditions under a single disability rating at 0%, coded 5019 (bursitis), citing no mechanical basis found for the limitation of motion.   This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI began having bilateral hip pain in October 2003 after a run.  Having failed conservative therapy, orthopedics wrote a permanent L3 profile and recommended an MEB in 2006.  During the 8 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported bursitis, numbness, and tingling in both hips.  The examiner noted bilateral trochanteric tenderness and discomfort with full range of motion (ROM).  At the 18 August 2006 MEB NARSUM examination, 7 months prior to separation, the CI reported bilateral hip pain, with only short term relief from steroid injections.  The examiner noted tenderness over the greater trochanteric bursa of the hips bilaterally.  There was good muscle strength and coordination.  The examiner referred to the ROM examination conducted by physical therapy, however the examiner recorded only passive ROM in the NARSUM.  

The ROM examination completed by physical therapy on 31 August 2006 showed right hip flexion of 60 degrees (normal 125), extension of 10 degrees (normal 20), abduction of 20 degrees (normal 45), adduction of 15 degrees (normal 45), and external rotation of 50 degrees (normal 45).  ROM of the left hip showed flexion of 70 degrees, extension of 5 degrees, abduction of 15 degrees, adduction of 10 degrees, and external rotation of 50 degrees.  Limitations were due to pain.

At the 13 September 2006 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported pain in both hips, stiffness and inability to walk long distances.  The examiner noted no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement, or guarding of movement in either hip.  Physical examination showed a normal gait.  ROM of the right hip showed flexion of 120 degrees, extension of 15 degrees, abduction of 40 degrees, adduction of 20 degrees, and external rotation of 56 degrees with painful motion reported.  ROM of the left hip showed flexion of 116 degrees, extension of 18 degrees, abduction of 42 degrees, adduction of 22 degrees, and external rotation of 54 degrees with painful motion reported.  ROM was not additionally limited with repetitive motion.

At the 30 October 2007 C&P examination the CI reported weakness when walking, stiffness when sitting, swelling when sitting for long periods, redness when walking or laying down, giving way when walking, lack of endurance when walking long distances, fatigability when walking, and sores and discoloration.  The examiner noted guarding of movement in both hips and painful motion.  Measurements showed right hip flexion of 90 degrees, extension of 30 degrees; abduction of 45 degrees, adduction of 20 degrees, and external rotation of 60 degrees. Left hip measurements showed flexion of 90 degrees, extension of 30 degrees, abduction of 30 degrees, adduction of 20 degrees, and external rotation of 40 degrees.  

A MEB PT ROM addendum dated 20 November 2006 stated the CI was able to assume cross leg position, both left and right with mild difficulty with no assist of hands.  Pain was noted to be the limiting factor.  The CI was able to externally rotate hips to 45 degrees bilaterally with no pain reported.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 0%, coded 5019 (bursitis), citing no mechanical basis could be found for the limitation of motion.  The VA rated the right and left hip conditions individually at 10% each, coded 5255 (femur, impairment of: with slight hip disability), citing painful motion as the major functional impact.    
The panel first considered if the hip conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  According to the commander’s statement dated 26 September 2006, the CI’s hip pain prevented her from conducting fueling operations and she was non-deployable.  The commander concluded with the statement that the CI was “totally incapable of performing her 92F MOS duties in combat as well as in garrison.”  It is reasonable to conclude that this functional assessment would have remained unaltered if only one hip was affected based on the physical nature of her MOS and the requirement that she march, bend, lift heavy machinery and remain physically active for long periods of time.  Panel members agreed the evidence reasonably justified that the functional limitations of each hip contributed to the CI’s inability to perform her military duties, and accordingly separate disability rating are recommended.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5252, 5251) for either hip.  However, there was evidence of painful motion in each hip with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each hip.  In the matter of the bilateral hip condition, the panel recommends that each hip joint be rated 10%, coded 5019, IAW VASRD §4.71a.  

BOARD FINDINGS:  In the matter of the right trochanteric bursitis condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5019 IAW VASRD §4.71a.  In the matter of the left trochanteric bursitis condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5019 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Trochanteric Bursitis	5019	10%	
Left Trochanteric Bursitis	5019	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170215, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004786, 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