RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02109
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080117

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

CI CONTENTION:  Review requested of arthritis from right femur surgery as well as right hip and lower back pain.  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 - 20071212	VARD - 20080516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Hip	5099-5003	10%	Residuals Status Post ORIF (Open Reduction Internal Fixation) of Fracture, Proximal Right Femur	5255	10%	20080503	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right hip surgery in July 2007 with cannulated screw fixation for a nondisplaced right femoral neck stress fracture.  On 14 August 2007, X-rays demonstrated three cannulated screws transfixing the healed femur neck stress fracture with bone and joint alignment intact.  Despite physical therapy and home exercises, the right hip pain persisted. 
The 16 October 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of chronic right hip pain.  Physical examination revealed abnormal posture and the need for crutches to bear full weight on the right leg.   There was hip tenderness and a well-healed, 2-cm surgical incision with staples on the right thigh without swelling or tenderness in the region.  The provider noted right hip weakness, “tenderness observed with ambulation,” and “abnormal” and painful motion.  There were no knee, leg (below the knee), ankle, foot or toe abnormalities.  During the 13 November 2007 MEB physical therapy examination, 2 months before separation, right hip goniometric-measured range of motion (ROM), in degrees, was: flexion to 120 (normal 125), extension to 0 (normal 20), and abduction to 30 (normal 45), with  painful motion.  Toe-out motion was greater than 15 degrees.

At the 3 May 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported right hip pain that could last from a few hours to 2-3 days, and was aggravated by weather changes, prolonged sitting or standing, and repetitive squatting.  He did not use crutches, braces, canes, or corrective shoes, and was employed as car engine builder, but could not lift over 60 pounds.  Physical examination showed a normal gait without foot drop, and no unusual shoe wear, callosities, or foot breakdown.  There was no deformity or bone disease signs; false motion or shortening; joint fractures; malunion, nonunion, or loose motion; or tenderness or edema.  Measured ROM, in degrees, showed right hip flexion to 110, extension to 20, abduction to 45, external rotation to 45 (normal), and internal rotation to 30; painful motion was absent.  Bilateral strength was full, with deep tendon reflexes at 2/4 and no gross sensory defects.  

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 slight and frequent pain with application of the US Army Physical Disability Agency pain policy.  The VA also rated the right hip condition 10%, coded 5255 (femur, malunion impairment with slight hip disability), based on the C&P examination, citing symptoms equivalent to a slight hip disability.  Members agreed that proximate to separation, there was no hip ankylosis (code 5250), thigh limitation of flexion or extension (codes 5251 and 5252), thigh impairment (code 5253), or hip flail joint (5254)  to support a higher rating than the 10% adjudicated by the PEB.  There was no femur nonunion or malunion causing a hip impairment (5255) to support a higher rating under that code.  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 chronic right hip pain 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180016343, 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