RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02499 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051110

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 bilateral hip pain” with a disability rating of 10%.

CI CONTENTION: “Continued pain and restricted mobility in Service connected disability.” 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 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 - 20051018	VARD - 20051123	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Bilateral Hip Pain	

5009-5003	

10%	Status Post Stress Fracture of Left Femoral Neck with Residual of Left Hip Pain	5009-5010	10%	20051003	
			Status Post Stress Fracture of Left Femoral Neck with Residual of Right Hip Pain	5009-5010	10%	20051003	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Bilateral Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic bilateral hip pain began in March 2005 during the first week of basic training. On 30 March 2005, bone scans showed stress fractures of both the right and the left femurs proximally and distally. The CI was placed on a 30-day convalescent leave and then physical therapy was initiated. The CI improved by August 2005 to the point he was able to do a 2-mile ruck march on a treadmill and was returned to regular duty. The CI reported return of bilateral hip pain and repeat X-rays on 22 August 2005 were normal and no further therapy was recommended. Hip X-rays on 23 August 2005 showed well healed femoral neck stress fractures and no surgery was indicated.

At a family practice examination on 31 August 2005 to discuss the MEB, 2 months prior to separation, the CI reported persistent pain in both hips. Physical examination showed full ROM of the hips with painful motion noted bilaterally. There was no tenderness of either hip. During the MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported sharp pain in the hips. Physical examination showed decreased range of motion (ROM) and tenderness of both hips. Right hip ROM was flexion of 90 degrees (normal 125), extension of 5 degrees (normal 30) and abduction of 32 degrees (normal 45) after repetition and left hip ROM was flexion of 88 degrees and abduction of 36 degrees. There was full ROM of the knees without tenderness. The MEB NARSUM examination noted complaints of moderate constant pain in the right and left femoral necks which required frequent use of crutches. Physical examination of the hips was as noted above on the DD Form 2808 examination.

At the 3 October 2005 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported bilateral hip pain. Physical examination showed a normal gait and the CI did not require an assistive device for ambulation. Examination of the right and left femurs was normal. Bilateral hip ROM measured in degrees was flexion 110, extension 30, abduction 45, and external rotation 60, with painful motion of both hips.

The panel directed attention to its rating recommendation based on the above evidence. The PEB bundled and rated the bilateral hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the Army pain policy. The VA rated the right and left hip conditions 10% each, dual coded 5099-5010 (analogous to traumatic arthritis), C&P examination, citing painful or limited motion of the hips.

The panel first considered if each of the right and left hip conditions having been de-coupled from the combined PEB adjudication, were reasonably considered separately unfitting at separation. In this case, both hips were profiled, implicated in the commander’s statement and failed retention standards. The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either hip over the other and the panel concluded that each hip was reasonably justified as separately unfitting and eligible for service disability rating.

The objective findings and associated disability for each hip were identical, and panel members agreed the respective ratings should therefore be the same. There was evidence of painful motion with functional loss supporting a 10% rating for each hip coded 5299-5252 (analogous to limited thigh flexion) and based on §§4.59, 4.40 and 4.45 and on the VA examination which was most proximate to separation. The panel considered rating the hip conditions analogous to femur impairment (5255), however, the panel agreed the disability of both hips was best characterized as slight based on the VA examination which showed a normal gait and hip ROM that was painful but within functional limits. 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 right hip condition and 10% for the left hip condition, both coded 5299-5252.

BOARD FINDINGS: In the matter of the bilateral hip condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting right and left hip condition, each rated 10%, both coded 5299-5252 IAW VASRD §4.71a. 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	
Right Hip Pain	5299-5252	10%	
Left Hip Pain	5299-5252	10%	
	COMBINED	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170218, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190015534, XXXXXXXXXXXXX 

Dear XXXXXXXXXXX

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. 

Sincerely,

Enclosure