RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03199
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080312

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic right hip pain” with a disability rating of 10%.   

CI CONTENTION:  His right hip pain supports a higher rating.  He 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 - 20071120	VARD - 20080930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	10%	Residuals, Right Hip Internal Fixation Surgery	5253	20%	20080616	
Bursitis Right Hip	Not Unfitting					
Neuralgia Right Upper Extremity	Not Unfitting	Numbness to Right Arm and Hand with Color Changes	8615	NSC	20080616	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right hip condition began in July 2006 after marching and heavy cannon crew drills.  Initially diagnosed as a strained hip, treatment included profile restrictions and medication.  On 28 September 2008, a bone scan revealed a “hot” spot in the right hip, which was determined to be a stress fracture to the femur neck.  Treatment included crutches and restriction modification.  In October 2006, an MRI showed that the fracture had not resolved and the CI underwent surgical fixation with screw placement of the right femoral neck.  

The 26 September 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant right hip pain aggravated with weight bearing on the right or with physical activity involving hip movement.  The provider noted near normal, but painful, right hip motion.   

At the 16 June 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant right hip pain described as burning, aching oppressing, sharp, sticking and cramping.  The pain was associated with weakness, stiffness, heat, giving way, lack of endurance, locking and fatigability, and he stated he was unable to run, climb, squat, or lift/carry items.  The provider noted that “at the time of pain he can function with medication.”  Physical examination revealed tenderness and guarding with right hip movement, and decreased range of motion, with flexion to 80 degrees (normal 125) and abduction to 30 degrees (normal 45).  Adduction was limited to 5 degrees (normal 25).    

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 the US Army Physical Disability Agency pain policy.  The VA rated the right hip condition as “residuals” of the hip pinning and rated 20%, coded 5253 (thigh, impairment of), based on the C&P examination, erroneously citing abduction (versus “adduction”) of the thigh limited to 5 degrees.  Members agreed that a rating higher than 10% was not justified in either pre- or post- separation examinations, noting equivalent ratings of 10% for either painful motion or limitation of adduction to the point of an inability to cross legs.  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 right hip condition.  

Contended PEB Conditions:  Bursitis Right Hip and Neuralgia Right Upper Extremity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the above 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 determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right hip bursitis and right upper extremity neuralgia conditions, 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.  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 20170410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010941, 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