RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2017-01792
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “right hip pain secondary to a healed pubic stress fracture” with a disability rating of 10%.  

CI CONTENTION:  Her condition continues to worsen and negatively impact daily activities.  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 - 20080715	VARD - 20090108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	10%	Residuals of Healed Inferior and Superior Pubic Rami Stress Fractures, Right Hip Pain	5252-5024	10%	20080728	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Hip Pain Secondary to a Healed Pubic Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in December 2006 after running during basic training.  She was able to “limp through” the rest of training although pain persisted.  X-rays taken in July 2007 showed a right inferior ramus fracture.  A CT scan August 2007 showed callus consistent with an old fracture but a fracture line was present.  A right hip MRI performed in January 2008 showed chronic and largely healed stress fractures of both the inferior and superior pubic rami (hip bones).  There was no surgical indication.

The 31 January 2008 MEB physical therapy examination showed goniometric-range of motion (ROM) of flexion to 110 degrees (normal 125) and extension to 10 degrees (normal 0); pain-limited motion was present.  She was able to cross her legs and could toe out bilaterally more than 15 degrees.  During the 20 February 2008 MEB NARSUM examination, 7 months before separation, the CI reported chronic right hip/pelvic pain related to the stress fracture.  Physical examination noted a slight limp favoring the right lower extremity; no assistive devices were utilized.  Motor and sensory testing was normal.  Bilateral reflexes were normal.  Pain was elicited with right hip internal and external rotation; quantified ROMs were not provided.  

At the 28 July 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported good response to current treatments.  Physical examination showed normal gait with right hip tenderness.  ROM was flexion to 115 degrees, extension to 20 degrees, abduction to 50 degrees, and adduction to 25 degrees; painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing pain limited motion and functional loss IAW VASRD §§4.10, 4.40, and 4.59.  The VA rated the right hip condition 10%, coded 5252-5024 (thigh, limitation of flexion-tenosynovitis), based on the C&P examination, citing painful motion.  

The panel agreed there was no limitation of right hip motion to support a 10% rating under codes 5250 through 5253.  However, there was satisfactory evidence of painful motion to support a 10% rating IAW VASRD §4.59.  There was no evidence of a femur impairment (code 5255) or other coding option to support a higher rating than the PEB’s adjudication.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 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 20170309, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008645 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