RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01607
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, HUMINT Collector, medically separated for “osteoarthritis bilateral hips” with a disability rating of 10%.  

CI CONTENTION:  In addition to the hip conditions, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060814	VARD - 20070326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Bilateral Hips	5003	10%	Degenerative Arthritis, Bilateral Hips	5250-5003	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Osteoarthritis Bilateral Hips.  The PEB combined the left and right hip conditions under a single disability rating, coded 5003 (degenerative osteoarthritis), and rated 10%.  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.  

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left and right hip conditions began insidiously in early 2004 after running.  Clinical encounters throughout the STR within 6 months of separation noted fleeting physical complaints of the CI’s pain being in just the right hip or both hips.  Occasionally, when symptoms were bilateral, the right hip was more painful than the left.  

During the 5 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the examiner documented full, but painful range of motion (ROM) of both hips.  Two weeks later (19 July 2006) at the MEB NARSUM examination, the CI complained of right hip pain when walking, running or with prolonged standing.  He endorsed having less pain in the left hip which mainly was associated with stretching activities.  The physical examination revealed painful and decreased ROM of both hips.  Right hip ROM testing showed flexion of 90 degrees (normal 125) and abduction of 20 degrees (normal 45).  Left hip testing showed flexion of 85 degrees and abduction of 20 degrees.  X-rays revealed arthritic changes in both hips.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The VA rated the bilateral hip condition 10%, analogously coded 5250-5003 (hip, ankyloses of-arthritis, degenerative) based on the STR, citing painful or limited motion of a major joint. 

The panel’s initial charge in this case was directed at determining if the PEB’s approach of combining both hips 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 indicated the condition was not unfitting.  In this case, both hips were considered to fail retention standards, both were implicated in the NARSUM and the commander’s statement and both were profiled.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the left and right hip conditions were separately unfitting.  The panel then considered its rating recommendation.  There was no compensable ROM limitation, however panel members acknowledged findings of painful motion warranting application of VASRD §4.59 for a rating of 10% for each hip, coded 5003.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends separate right and left hip ratings of 10% each.

BOARD FINDINGS:  In the matter of the bilateral hip condition, the panel recommends that each hip joint be separately adjudicated as follows: an unfitting left hip, coded 5003 and rated 10%, and an unfitting right hip, coded 5003 and rated 10%, both IAW VASRD §4.71a.  There were 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	
Left Hip 	5003	10%	
Right Hip	5003	10%	
COMBINED	20%	

AR20190004116, XXXXXXXXXX

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Dear XXXXXXXXXX:

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.