RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01045
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Parachute Rigger, medically separated for “chronic bilateral groin thigh pain” with a disability rating of 10%.  

CI CONTENTION:  The VA rated her higher, accounting for both hips and the condition continue to worsen and negatively impact daily activities.  The CI also petitions for conditions not identified by either the MEB or PEB.  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 - 20050916	VARD - 20060119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Groin Thigh Pain…	5099-5033	10%	Femoral Adductor Strain, Left	5315	10%	20051006	
			Femoral Adductor Strain, Right	5315	10%	20051006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Bilateral Groin Thigh Pain.  The PEB combined the left groin pain and right groin pain conditions under a single disability rating, coded analogously to 5003 and rated 10% with application of the U.S. Army Physical Disability Agency pain policy and AR 635-40 B24.f.  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 noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  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.  The evidence for the left groin pain and right groin pain conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s chronic bilateral groin pain condition began in July or August of 1999 during basic training when she reportedly pulled her groin muscles bilaterally.  No trauma or injury was noted.  In September 1999 she was found to have bilateral stress fractures of the hip.  Treatment was with medication, rest, and profiles. Thereafter, she had intermittent exacerbations of hip pain.  In July 2002 X-rays of the pelvis revealed asymmetry of the iliac crest with the right being slightly smaller and asymmetry of the pelvic ring.  No acute osseous abnormalities were noted.  Pain continued and she underwent extensive physical therapy and continued medication use.  

A note dated 23 May 2005 indicated the CI had pain of both greater trochanters of her femurs, which radiated to her groin bilaterally.  On examination there was a full range of motion (ROM) of the hips and a normal gait.  ROM measurements of the left hip on 31 May 2005 in degrees were flexion 130 (normal 125), extension 25 (normal 20), external rotation 26 (normal 45), abduction 31 (normal 45), and adduction 30 (normal 25), while the right hip the ROM measurements in degrees were flexion 130, extension 26, external rotation 31, abduction 30, and adduction 30.  Whether pain was present or not was not mentioned.  

During the 21 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bursitis in the hips.  Physical examination showed no erythema, edema or spasms bilaterally.  Focal areas of tenderness were present over the trochanteric areas bilaterally and pain was noted in the same areas in all movements. Straight leg raising (to determine nerve root irritation) was negative.  No weakness was present, but there was slight limitation of movement noted in external rotation and abduction due to pain.  The 27 June 2005 MEB NARSUM examination, 5 months prior to separation, noted the complaint of daily constant groin pain, which was aggravated by prolonged walking, standing and bending.  MEB physical examination findings were incorporated into the NARSUM physical examination.  

At the 6 October 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported bilateral groin pain and weakness.  Physical examination showed her gait was within normal limits and she did not use an assistive device for ambulation.  The examiner noted muscle group XV was involved and strength was graded at four.  There was no muscle herniation and the muscle injury did not involve any tendon, bone, joint, or nerve damage.  The right and left hip joints appeared within normal limits.  ROM measurements of the right and left hip were normal with pain.  Joint function on the left and right were limited after repetition by pain, but not fatigue, weakness, lack of endurance or incoordination.  X-rays of the left and right hips were normal. 
 
The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB bundled the left groin pain condition with the right groin pain condition and applied a single 10% rating, coded 5099-5003 (arthritis, degenerative) citing constant and minimal pain under the U.S. Army Physical Disability Agency pain policy.  The VA rated the left groin pain condition 10%, coded 5315 (moderate Group XV muscle injury), and the right groin pain condition 10%, coded 5315, based on the C&P examination 1 month before separation, citing normal X-rays, no muscle atrophy, and some limitation of motion.  

The panel first considered whether the left groin pain was reasonably justified as separately unfitting as established above.  Members agreed was that the evidence supports the functional limitations of the left groin pain, which could be reasonably justified as separately unfitting, and a separate Service rating is recommended.  The panel then considered whether the right groin pain was reasonably justified as separately unfitting as established above.  Members agreed it was and that the evidence supports the functional limitations of the right groin pain, which could be reasonably justified as separately unfitting, and a separate rating is recommended for each condition.  In this case, both the left and right groin pain under the rubric of “groin pain” were profiled, was considered to fail retention standards, was implicated by the NARSUM (“chronic bilateral groin pains”) and was mentioned in the commander’s statement (by referring to her history of bilateral stress fractures and the P3 profile).  

Members agreed that the left groin pain and the right groin pain are separately unfitting and that identical coding and ratings are applicable.  Members noted that although the reported ROMs at the physical therapy and VA examination were non-compensable relating to limitation of motion (codes 5251, 5252, and 5353), the MEB examiner reported pain in all movements, while the physical therapy examiner was silent in regard to painful motion.  However, the VA examination was most proximate to separation and was of a higher probative value than antecedent examinations.  Painful motion was present with flexion, abduction and adduction bilaterally.  Therefore, a 10% rating, coded 5099-5003 is warranted for the left groin pain and a 10% rating, coded 5099-5003 is warranted for the right groin pain, each of which had demonstrable painful motion IAW VASRD §4.59 (painful motion).  There was no route to a higher rating for either the left or the right groin pain in the absence of hip ankylosis (code 5250), hip flail joint (code 5254), or documented femur impairment (code 5255) proximate to separation nor did any muscle code (codes 5315-5318 (Groups XV-XVIII)) offer an additional benefit in the absence of a moderately severe muscle injury, which was neither reported nor documented.  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 left groin pain condition and a disability rating of 10% for the right groin pain condition, each coded 5099-5003.  

BOARD FINDINGS:  In the matter of the bilateral groin pain condition, the panel unanimously recommends that each groin pain be separately adjudicated as follows: an unfitting right groin pain condition coded 5099-5003 and rated 10%, and an unfitting left groin pain condition, coded 5099-5003 and rated 10%, both IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Groin Pain, Left	5099-5003	10%	
Bilateral Groin Pain, Right	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005737, 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