RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01371
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Power Generation Equipment Repairer, medically separated for “bilateral hip pain” with a combined disability rating of 10%.  

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 - 20051128	VARD - 20060928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain, Right Greater than Left	5099-5003	10%	Labral Repair And Psoas Release of the Right Hip, Claimed as Pain	5252	10%	20060624	
Post-Traumatic Stress Disorder (PTSD)	Not Unfitting	Depression, Claimed as Suicidal/Homicidal Depression	9434	10%	20060615	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Bilateral Hip Pain, Right Greater than Left.  The PEB combined the left and right hip conditions under a single disability rating, analogously coded 5099-5003 and rated 10% with application of the US Army Physical Disability Agency pain policy.  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.  

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right hip arthroscopic labral repair surgery in January 2005.  Recovery was uneventful; however, when the CI returned to work there was a notable increase in pain.  The 16 May 2005 MEB NARSUM examination, 10 months prior to separation, noted complaints of continued bilateral hip pain, which significantly limited his ability to perform his job as a mechanic.  He was unable to perform basic soldiering skills of firing his weapon with his gear, ruck running, and marching.  Physical examination showed range of motion (ROM) of the right hip with forward flexion of 100 degrees (normal 125) and abduction of 45 degrees (normal), both with discomfort.  Left hip showed 105 degrees of flexion and 50 degrees of abduction with mild pain at the extremes of ROM.  Physical therapy (PT) ROM measurements of 10 August 2005, 7 months prior to separation, recorded passive ROM and not active ROM.  Passive right hip flexion was 120 degrees (normal 125) and abduction of 51 degrees (normal 45).  Passive left hip flexion was 122 degrees and abduction of 43 degrees.  Pain was noted with bilateral flexion and extension and right hip adduction.  During the 10 November 2005 NARSUM addendum, 4 months prior to separation, the CI reported right greater than left hip pain that had a burning pain character.  The left hip pain was felt to be a result of his antalgic gait (compensating for the right hip) and the constant stepping up and down from the 2½ foot generator trailers.   The hips were noted to be stable, but with a poor prognosis for return to full duty.  The examiner noted the CI did not meet retention standards.  

At the 24 June 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported he initially had pain in the right hip and surgery provided some relief, but since then he had experienced pain in both hips which progressively worsened.  The bilateral hip pain increased with activity or with sitting for long periods of time.  Physical examination found he could cross his legs without pain and there was no muscle weakness or atrophy.  ROM documented flexion in both hips to 100 degrees and abduction of 40 degrees bilaterally.  There was no pain with motion and no additional loss in motion with repetitive use.  

As noted above, the PEB bundled the right and left hip conditions and applied a single 10% rating coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the right hip condition 10%, coded 5252 (thigh, limitation of flexion of), based on the C&P examination, citing continued pain with decreased range of motion with functional limitation.  The left hip was deemed not service connected, citing no diagnosis.  

The panel first considered if each hip condition, when decoupled from the combined PEB adjudication, remained separately unfitting as established above.  Both hips were considered to fail retention standards and “hip pain” was profiled.  The commander stated the CI’s MOS required working and climbing on generators to repair them.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the bundled hip condition was reasonably considered separately unfitting.  The panel then considered its rating recommendations at the time of separation.  Panel members considered that the objective findings and associated disability for each hip were similar in regards to functional impairment at the time of separation, and agreed that the respective ratings should therefore be the same.  There was no limitation of flexion, extension, or abduction that supported a rating under the VASRD diagnostic codes 5251, 5252 or 5253 for limitation of motion. There was no fracture, nonunion, or malunion of the femur to support consideration under the 5255 code.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40, and 4.45) as reflected on the MEB NARSUM and the PT ROM examination.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left hip condition and 10% for the right hip condition, both coded 5099-5003.  

Contended PEB Condition:  PTSD.  The panel’s main charge is to assess the fairness of the PEB’s determination that PTSD was not unfitting.  PTSD was profiled and the commander acknowledged and signed the S3 profile.  However the commander’s statement did not indicate any mental health condition interfered with the performance of duties.  The August 2005 psychiatry NARSUM diagnosed PTSD, mild severity, and stated the condition did not meet retention standards.  The panel found it curious that the NARSUM examiner opined that the CI’s condition rendered him severely impaired, yet found him to have good insight and good judgment with mild severity of PTSD.  There was no clinical evidence of severe impairment in the STR as the result of PTSD.  The panel also noted an inpatient admission to psychiatry in November 2005.  The CI was admitted after he reported suicidal ideation to the emergency room physician.  Diagnoses recorded were major depressive disorder and personality disorder.  His discharge diagnosis was depressive disorder, not otherwise specified, and he was noted to have improved significantly.  The single identified stressor was conflict with the unit.   The VA C&P examiner did not diagnose PTSD and noted that full criteria for PTSD were not met. The panel acknowledged there were other psychiatric conditions diagnosed, however, the panel is unable to review conditions that are not within the scope of review as addressed above.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for PTSD, so no additional disability rating is recommended.  

BOARD FINDINGS: In the matter of the bilateral hip condition, the panel recommends a disability rating of 10% for the left hip and 10% for the right hip, both coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended PTSD condition, the panel recommends no change from the PEB determination as not unfitting.  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	
Chronic Right Hip Pain	5099-5003	10%	
Chronic Left Hip Pain	5099-5003	10%	
COMBINED	20%	

AR20180013238, 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.