RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00519
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Health Care Specialist, medically separated for “chronic pain due to bilateral trochanteric bursitis” 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 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 - 20050608	VARD - 20051213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain…Bilateral Trochanteric Bursitis	5019	0%	Right Hip Chronic Bursitis	5255-5024	10%	20050817	
			Left Hip Chronic Bursitis	5255-5024	10%	20050817	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Bilateral Trochanteric Bursitis.  The PEB combined the right and left hip trochanteric bursitis conditions under a single disability rating, coded 5019 (bursitis).  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’s bilateral trochanteric bursitis (hip) condition began in November 2002 during advanced individual training.  No trauma or injury was cited.  X-rays of both hips on 6 November 2004 were normal.  The 10 March 2005 internal medicine examination, 3 months prior to separation, noted complaints of bilateral hip pain.  Physical examination showed normal, pain free, bilateral hip motion.  The 07 April 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of bilateral hip pain.  Physical examination showed tenderness over both trochanteric bursae.  There was full range of motion (ROM) in both hips.  The 20 May 2005 MEB physical therapy ROM evaluation showed painful motion in both hips with (left/right) hip flexion of 100/95 degrees (normal 120), extension 10/10 degrees, adduction 35/30 degrees, abduction normal, internal rotation 42/35 degrees, and external rotation 44/40 (normal 45).  

At the 17 August 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported bilateral hip pain which increased with prolonged standing and running.  The pain was relieved with sitting.  Physical examination showed a normal gait.  Hip ROM was noted at 120 degrees of flexion, 40 degrees of external rotation, 40 degrees of abduction, and 20 degrees of adduction bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 0%, analogously coded 5019, citing no limitation of motion.  The VA rated each hip condition 10%, analogously coded 5255-5024 (femur, impairment-tenosynovitis), based on the C&P examination, citing limitation of motion.  The panel first considered if the bursitis condition met the panel’s threshold for separate rating (as elaborated above).  In this case, both hips were considered to fail retention standards, both were implicated by the NARSUM and the commander’s statement, and both were profiled.  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.  There was no limitation of motion or painful motion which supported a rating under the diagnostic codes for limitation of flexion or extension nor 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 bilateral trochanteric bursitis condition.  

BOARD FINDINGS:  In the matter of the bilateral trochanteric bursitis condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10% for each hip and elected not to submit a minority opinion.  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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004694, 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