RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02218
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “bilateral hip pain” with a disability rating of 20%. 

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 - 20081210	VARD - 20100202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip Pain	5099-5003	20%	Left Hip Strain	5252	10%	20091104	
			Right Hip Strain	5252	10%	20091104	
Adjustment Disorder 	Not Unfitting	Bipolar Disorder with Personality Disorder, NOS 	9432	30%	20091104	
Personality Disorder, NOS	Not Unfitting					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  Even though the PEB combined the right and left hip conditions on the DA Form 199 under a single 20% rating, it actually rated each hip 10% separately for a combined rating of 20% with application of the bilateral factor.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI entered active duty on 15 April 2008.  She was first seen for musculo-skeletal complaints on 21 April 2008 when she reported bilateral foot pain.  She was seen again on 26 April 2008, 11 days after accession, reporting bilateral knee and foot pain.  A bone scan on 28 April 2008 did not show stress fractures; no comment was made regarding stress reactions.  She continued training and had a left ankle sprain on 16 May 2008.  She was able to complete training and a primary care note dated 20 June 2008 recorded that she had no musculo-skeletal complaints.  She was then sent to the Army Airborne School but could not complete the course due to left hip pain which she reported had begun in basic training, but had resolved until she began airborne training.  In primary care on 1 August 2008, she was found to have bilateral hip tenderness and pain with motion.  X-rays of the more symptomatic left hip were normal and on 19 August 2008, X-rays of the pelvis and bilateral hips were normal.  A bone scan 3 days later showed stress reactions of the hips, knees and shins.  She was then medically dropped from the airborne training and transferred to a new post for AIT.  She was also reclassified into a new MOS.  There she reported ongoing bilateral hip pain.  She again had tenderness and painful motion, but a normal gait and stance.  In follow-up on 3 September 2008, she reported ongoing pain.  Tenderness was present and motion painful on the left, but the gait and stance were normal.  Her pain persisted and the examination remained stable over the next few visits.  

During the 8 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, she had painful motion of the hips.  The physical therapy range of motion (ROM) study showed, after repetition, right hip flexion of 110 (normal 125) and left hip flexion of 115 degrees; extension of 0 degrees (normal), bilaterally, and right hip abduction of 40 degrees (normal 45) and left hip abduction of 30 degrees.  The CI was able to cross and toe out greater than 15 degrees bilaterally.  Motion was limited by pain.  

The 4 November 2008 MEB NARSUM examination, 2 months prior to separation, noted the CI had been referred by her commander for a fitness for duty evaluation due to her hips.  The physical examination showed a normal gait and transfer of positions (sitting to standing, etc.)  Some motion was painful though.  She was thought to have bilateral hip pain without a specific diagnosis.  

At the 4 November 2009 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported left greater than right hip pain which began in basic training.  The physical examination showed tenderness and pain with motion.  The ROM study showed bilateral hip flexion of 120 degrees, extension of 20 degrees, abduction of 40 degrees, external rotation of 60 degrees and internal rotation of 30 degrees.  X-rays were normal.  The gait was guarded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 20%, (stipulating 10% for the right and 10% for the left) coded analogously 5099-5003 (degenerative arthritis), citing painful motion.  The VA rated each hip 10%, coded 5252 (thigh, limitation of flexion of), based on the C&P examination, citing limited and painful motion.  The panel noted that none of the codes specific for the hip provided a rating higher than the 10% adjudicated by the PEB and VA for each hip.  After due deliberation, considering all of 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 bilateral hip condition.  

Contended PEB Conditions:  Adjustment Disorder and Personality Disorder, NOS.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The CI carried an S3 profile.  The mental health (MH) addendum, dated 7 November 2008 and 2 months prior to separation, noted these MH disorders failed retention standards, but only the hip conditions were implicated in the commander’s statement and the CI was noted to be working an 8 hour day effectively.  A review of STR entries from 29 April 2008, 2 weeks after accession, through 8 October 2008, noted that 3 of the 8 STRs recorded a MH symptom and 5 of the 8 recorded no symptoms.  Multiple other notes were silent regarding MH status.  At both military and VA evaluations, the CI reported that significant MH issues were present prior to accession including multiple suicide attempts.  The PEB noted that both conditions were considered by the PEB and determined to be non-compensable, although both may be administratively unfitting.  The panel also observed that IAW DoDI 1332.38 E5.1.2.9, both conditions were considered developmental defects and did not constitute physical disabilities for rating purposes.  Regardless, the preponderance of evidence from the record does not show that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder and personality disorder, the panel recommends no change from the PEB determinations as not compensable.  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 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008220, 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