RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03227
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070610

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Electrician’s Mate, medically separated for “bilateral hip degenerative joint disease [DJD]” rated 10% and 0% for each hip, with a combined disability rating of 10%.

CI CONTENTION: “The medical condition that I was medically discharged for have progressively gotten worse and I had (18) eighteen years (7) seven months honorable service when I was discharged.” 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 - 20061103	VARD - 20071107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip DJD*	5299-5003	0%	Right Hip DJD	5003-5252	10%	20070411	
	5299-5003	10%	Left Hip DJD	5003-5252	10%	20070411	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	
* The PEB specified separate ratings as charted, but did not annotate right versus left for the assigned ratings. Deducing from reported findings, it is most likely the higher rating was for the left hip.

ANALYSIS SUMMARY:

Bilateral Hip DJD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an atraumatic onset of progressively worsening bilateral hip pain in 1997. Imaging (serial X-rays and MRI) demonstrated degenerative changes (left “moderate,” right “mild”). Provider entries in the STR documented pain greater on the left than the right, grossly normal or non-specifically limited range of motion (ROM) of both hips, with no indication of significantly severe ROM limitation but documentation of bilateral painful motion. There was documentation of a normal gait and joint strength with no indication of functional impairment of routine activities. There was no evidence for any additional VASRD-ratable criteria.

The 10 August 2006 MEB NARSUM examination, 10 months prior to separation, documented nonspecific bilateral hip pain without differentiating left versus right severity or elaborating functional limitations. The physical examination recorded a “significant” decrease in ROM of both hips and pain with stress maneuvers, although not addressing pain on active motion. There was no documentation of gait disturbance, tenderness, joint instability or impingement, or other positive findings. The ROM measurements provided were flexion to 90 degrees bilaterally (normal 125) and external rotation to 30 degrees right and 15 degrees left (normal 45).

At the 11 April 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant bilateral hip pain rated 7/10 (no differentiation of left versus right severity) that limited prolonged standing and walking. The physical examination recorded a normal gait, tenderness and guarding of each hip, and normal bilateral joint strength. There was no note of other positive findings. ROM measured in degrees (all bilateral and identical) was flexion to 110, extension to 30 (normal), external rotation to 45, abduction to 45 (normal), and adduction to 25 (normal), specifying bilateral painful motion in some planes but no ROM degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated each hip separately unfitting as charted above (see footnote), coded 5299-5003 (analogous to degenerative arthritis). The VA rated each hip 10%, coded 5003-5252 (degenerative arthritis rated for limitation of flexion), citing painful motion. There was no evidence for limitation of motion in any plane which supported the minimum 10% rating under the applicable codes (5252, 5252, and 5253), with the exception that the NARSUM measurement of 15 degrees external rotation for the left hip satisfied a 10% criterion of code 5253 (thigh, impairment). Panel members agreed, however, there was satisfactory evidence of painful motion for each hip in the most temporally probative pre-separation VA C&P examination (corroborated by STR provider notes). This would provide for a minimum 10% rating for each hip IAW §4.59 (painful motion). There was no ankylosis (5250) or flail joint (5354) that would support a higher rating under the remaining VASRD §4.71a joint codes. Panel members further agreed there was no evidence of sufficient functional impairment to justify a higher rating under code 5299-5255 (analogous to femur, impairment) that provides for rating of contiguous hip disability. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for each hip under code 5003.

BOARD FINDINGS: In the matter of the bilateral hip condition, the panel recommends a disability rating of 10% for each joint, coded 5003 IAW VASRD §4.59 and §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Degenerative Arthritis, Right Hip	5003	10%	
Degenerative Arthritis, Left Hip	5003	10%	
	COMBINED	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 28 Jan 20
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.