RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02628
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Chemical Operations Specialist, medically separated for “snapping hip syndrome, left,” with a disability rating of 0%.  

CI CONTENTION:  In addition to the left hip condition and hearing loss, 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 - 20050816	VARD - 20060804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Snapping Hip Syndrome, Left 	5099-5003	0%	Degenerative Joint Disease, Left Hip	5252	10%	20060727	
Decreased Sensation Anterior Thigh	Not Unfitting	Meralgia Paresthetica, Left Hip	8626	10%	20060727	
Mild Sensorineural Hearing Loss	Not Unfitting	Hearing Loss, Left Ear	6100	0%	20060727	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Snapping Hip Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left hip condition began in April 2003 with onset of numbness and tingling at the left anterior thigh with shooting pain occasionally radiating to the toes.  A bone scan performed on 12 May 2004 revealed mild persistent stress reactions in both hip joints.  Range of motion (ROM) was full, but painful on 20 January 2005. 

During the 27 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI complained of continued left hip pain.  Her physical examination (PE) revealed tenderness about the left hip.  Hip ROM was near normal noting forward flexion to 120 degrees (normal 125).  At the 19 July 2005 MEB NARSUM examination, 4 months prior to separation, the CI reported continued left hip pain with wear of load-bearing equipment or flack vest.  She endorsed having difficulty with mounting and dismounting repetitively as well as with squatting and sitting for prolonged periods of time.  Her PE revealed a “slightly antalgic gait.”  There was full ROM of both lower extremities; however, a “snapping” of the left hip was present on internal and external rotation.  Additionally, there was decreased sensation over the front and side of the left thigh.   

During the 27 July 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain, stiffness and limited motion of the left hip. Additionally, she endorsed numbness and tingling of the left lateral thigh.  The PE revealed a normal gait and normal, but painful, left hip ROM.  There was decreased sensation to light touch, vibration and pinprick along the left lateral thigh.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing abnormal radiologic findings.  The VA rated the left hip condition 10%, coded 5252 (thigh, limitation of flexion of), based on the C&P examination, citing painful and limited ROM.   All panel members agreed that although the pre-separation examinations proximate to separation did not address or make comment with regards to painful motion, the January 2005 ROM examination supported a 10% rating for painful motion UP VASRD §4.59.  Absent persistent fracture without nonunion or malunion and/or the presence of hip disability greater than ‘slight,’ there was no impairment rating higher than 10% for the left hip.  There was no coexistent pathology which would merit additional rating for the hip condition under any other code.  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 left hip condition, coded 5099-5003.

Contended PEB Conditions:  (Mild Sensorineural Hearing Loss and Decreased Sensation Anterior Thigh.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The hearing loss was not profiled, implicated in the commander’s statement or judged to fail retention standards.  However, the decreased thigh sensation was profiled and judged to fail retention standards.  Panel members first acknowledged the presence of decreased sensation about the lateral aspect of the left hip both at 4 months prior to separation and apparently unchanged 12 months later at 8 months after separation.  In either examination, the sensory deficit failed to be quantified or attributed to any adverse functional residual.  Therefore, members agreed that there was no performance-based evidence from the record that either of the contended conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determinations for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left hip condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended decreased sensation of the anterior left thigh and hearing loss, the panel recommends no change from the PEB determinations as not unfitting.  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	
Snapping Hip Syndrome, Left 	5099-5003	10%	

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  

AR20190009131, 

Dear XXXXXXXXXXXXXXXX:

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.