RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00748
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Human Resources Specialist (Trainee), medically separated for “chronic right hip pain” with a disability rating of 0%.   

CI CONTENTION:  “I want my disability rating increased, due to the severity of my disability increasing over time.”  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 - 20090320	VARD - 20111116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	0%	Right Pubic Ramus Stress Fracture	5251-5024	10%	20111004	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to service treatment records and MEB narrative summary (NARSUM), the CI’s right hip condition began in August 2004 during a group run, when she fell and landed on her right hip.  The CI reported immediate pain requiring the use of crutches for 3 months.  X-ray studies of the pelvis showed a healing right inferior pubic ramus stress fracture.  At physical therapy on 23 February 2009, examination revealed a normal gait with 4+/5 tenderness of the right hip and normal range of motion (ROM).  The 26 February 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic right hip pain with flare-ups when going up and down stairs.  She denied radiating pain, weakness or paresthesias.  Physical examination showed a normal gait and stance.  She got on and off the examination table without difficulty.  There was no bony or soft tissue tenderness.  There was no weakness or incoordination or lack of endurance noted, but there was tenderness over the right greater trochanter of the hip, but no other bony or soft tissue tenderness or ligamentous laxity.  The ROM measurements after repetition were right hip flexion 120 degrees (normal 125), extension 10 degrees (normal 20), and abduction 25 degrees (normal 45).  She was able to toe out more than 25 degrees with either foot and was able to cross either leg over the other without significant discomfort.  Neurologic evaluation was unremarkable.  The examiner noted the CI described flare-ups in her hip pain with simple activities and had significant limitation in the right hip flexion and abduction.  She was able to push through the pain an additional 10 degrees in right hip flexion and 5 degrees in right abduction.  As a result the NARSUM examiner opined she may have additional limitation of 10 degrees of right hip flexion and 5 degrees of right hip abduction due to flare-ups or repeated use.  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 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing healed stress fractures and “this rating includes consideration of functional loss IAW VASRD 4.10, 4.40, 4.45, and 4.59.”  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (codes 5252 or 5251) or thigh impairment (code 5253).  There was no hip ankyloses (code 5250) or hip flail joint (code 5254).  There was no femur impairment per se, but there was a healing right inferior pubic ramus stress fracture; therefore, thigh impairment using code 5299-5255 offers a rating option of 10%, and no higher, for malunion with slight knee or hip disability.  There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) using code 5099-5003.  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 5099-5003.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel recommends a disability rating of 10%, coded 5099-5003 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Hip Pain	5009-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004806, 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