RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01038
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Petroleum Supply Specialist, medically separated for “right hip pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that her right hip was rated higher by the VA.  She also contends that her left hip, bilateral knees and mental disorders should have been rated by the service.  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 - 20081212	VARD - 20090623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture of the [Right] Femoral Neck and Acetabulum	5299-5255	10%	Residuals of Hip Stress Fracture with Spur Formation, Right Hip	5252	20%	20090325	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Stress Fracture of the [Right] Femoral Neck and Acetabulum.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s right hip condition began in January 2008 while attending basic military training.  There was no history of any specific trauma.  During an 8 August 2008 evaluation at the orthopedic clinic she was diagnosed with a stress fracture of the right acetabulum and femoral neck based on MRI and other radiographic studies.  At the 19 September 2008 orthopedic clinic examination, the range of motion (ROM) of the right hip was normal.  

During the 2 October 2008 MEB NARSUM examination, 3 months prior to separation, the CI noted complaints of unmanageable right hip pain.  The examiner noted tenderness on palpation, but no spasm or muscle atrophy.  At a physical therapy appointment on 23 October 2008, the examiner noted painful motion and measured the right hip flexion to 70 degrees (normal 125), extension to 15 degrees (normal 20), abduction to 30 degrees (normal 45), and was able to toe out over 15 degrees.  All measurements were with a goniometer and did not change after three repetitions.  

At the 25 March 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent right hip pain.  Physical examination showed right hip flexion of 28 degrees, extension of 10 degrees and abduction of 10 degrees.  There was pain with motion and the examiner noted that the CI had the ability to cross the right leg over the left and could toe out over 15 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5299-5255 (femur, impairment of), citing the ability to toe out and cross her legs indicating a slight disability.  The VA rated the right hip condition 20%, coded 5252, (thigh, limitation of flexion of), based on the C&P examination 3 months after separation, citing limitation of flexion of the right hip.  The panel noted the disparity between the physical therapy and VA ROMs.  The panel placed higher probative value on the STR and NARSUM examination in evaluating the CI’s disability at the time of separation because of the consistency of the ROM.  There was no pre-separation limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or abduction (5251, 5252, and 5253).  However, there was evidence of painful motion 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 that 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 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 20170219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005507, 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