RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03229
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “osteoarthritis, bilateral hips” with a disability rating of 10%.  

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities.  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 - 20070111	VARD - 20070419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Bilateral Hips 	5003	10%	Rt Hip Strain w/ Degenerative Changes 	5299-5252	10%	20070109	
			Lt Hip Strain w/ Degenerative Changes 	5299-5252	10%	20070109	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Hip Osteoarthritis.  The PEB combined the left and right hip osteoarthritis conditions under a single disability rating, coded 5003, and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left hip conditions are presented together as the majority of clinical encounters were for bilateral hip pain.  However, individual recommendations were made regarding separate unfitness, if indicated, separate ratings.  

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented with right thigh and then left hip pain in early 2006, and reported a 4-year history of bilateral hip pain with no specific trauma.  In primary care on 6 April 2006, the range of motion (ROM) of both hips was normal, and X-rays as well as an MRI showed bilateral degenerative changes.  On 11 July 2006, a physical therapist noted full, but painful bilateral hip ROM as well as a normal gait.  His symptoms increased with running and improved with rest.  In orthopedics on 21 July 2006, the CI reported a 4-5 year history of pain without trauma.  It was aggravated by activity and persisted despite physical therapy and medications.  The ROM was nearly full and pain-free, however, one month later in primary care, he had painful ROM.  

During the 21 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain when he ran fast.  The provider documented ROM limited by pain, but did not provide measurements.  A test for hip pathology (FABER) was positive, with the right side greater than left.  

The 4 December 2006 MEB NARSUM examination, 3 months prior to separation, documented CI complaints of bilateral hip pain since 2003, and the provider noted “osteoarthritis at the hip, etiology unclear.”  The physical examination showed normal strength, but markedly limited and painful ROM, with right hip flexion to 65 degrees (normal 125) and adduction to 15 degrees; and left hip flexion to 95 degrees and adduction to 15 degrees.  Gait was not mentioned.  

At the 9 January 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported a 3-4 year history of bilateral hip pain, but denied incapacitation.  The physical examination showed a normal posture and gait with no use of an assistive device.  Bilateral inspection of the hips was normal without evidence of swelling or tenderness.  The ROM was painful, but full, other than external rotation limited to 45 degrees (60 is normal) on the left.  Pain increased with repetition, but did not cause additional functional limitations.  

The panel first considered whether each hip was separately unfitting.  Both hips were profiled, found medically unacceptable, and implicated by the commander.  Although the left hip was more symptomatic, both hips had radiographic evidence of degenerative change, and thus, members determined that each hip was individually unfitting at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 10%, coded 5003 (degenerative arthritis), citing “without ratable limitation of motion” and “X-ray evidence, two major joints.”  The VA rated each hip 10%, both analogously coded 5299-5252 (limitation of flexion of thigh), based on the C&P examination, citing painful motion.  Members agreed that a 10% rating, but no higher, was justified for frequently documented painful and limited motion. Other coding options specific to the hip did not support a compensable rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for each hip condition, coded 5003.  

BOARD FINDINGS:  In the matter of the right hip osteoarthritis, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the left hip osteoarthritis, the panel recommends a disability rating of 10%, coded 5003 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 Osteoarthritis	5003	10%	
Left Hip Osteoarthritis	5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180009124, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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