RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03268
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “femur stress reactions, bilateral hips,” rated 10% each with a combined disability rating of 20%. 

CI CONTENTION:  The condition continues to worsen and negatively affects 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 - 20081017	VARD - 20090513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Femur Stress Reactions, Bilateral Hips	5299-5255	10%	Residuals Stress Fracture Right Femoral Neck	5299-5255	10%	20090218	
		10%	Residuals Stress Fracture Left Femoral Neck	5299-5255	10%	20090218	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Femur Stress Reactions, Bilateral Hips.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in March 2005 after a two mile run.  X-rays were normal and a bone scan was negative. The CI subsequently deployed in September 2006 and completed a 15-month.  An MRI in May 2008 suggested stress reactions in the femoral neck bilaterally and proximal femora (thigh bones).  X-rays in July 2008 of the right and left hips showed increased sclerotic changes representing further healing of the underlying stress injury.  The greater right tuberosity showed a radiolucent defect, which may have represented cystic changes.  Demineralization of the greater left trochanter may have represented cystic changes.  

During the 11 August 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right hip pain.  Physical examination revealed the CI was in a wheelchair, but was able to ambulate.  X-rays showed stress reactions of the femoral neck bilaterally, but MRIs of the hips were normal.  

The 29 September 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of increased pain when bending, climbing, walking or standing.  She used a wheel chair and crutches when she was unable to get into buildings with her wheelchair.  Physical examination showed hip range of motion (ROM) measurements in degrees of right flexion 85 (normal 125), left flexion 75, right abduction 31 (normal 45), left abduction 25, right adduction 11 (normal 25), left adduction 25, right extension and left extension 15 degrees (normal 20), all with pain.  The CI was tender bilaterally on the femur heads.  Motor strength was normal for flexion, extension, abduction and adduction.  The test (to rule out a hip flexion contracture) was positive for the left hip; the Faber test (to determine hip pathology) was positive bilaterally.   

At the 18 February 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant pain and popping in the hips.  She denied weakness, stiffness, swelling, heat, redness, instability, giving way, locking, fatigability or lack of endurance.  The CI was able to walk unaided and did not use a cane, crutches, walker, brace, corrective shoes, or any orthotics.  Physical examination showed she was able to transfer from a chair to examination table without any difficulty.  Her gait was smooth and steady and there were no functional limitations on standing and walking.  There was no instability of either hip.  The ROM measurements for the left hip in degrees were flexion of 125, extension of 30, adduction of 25, abduction of 45, external rotation of 60 (normal), and internal rotation of 40 (normal).  There was no pain or loss of motion with repetition.  There was tenderness in the right inguinal region.  ROM measurements of the right hip in degrees were flexion of 90, extension of 10, adduction of 10, abduction of 25, external rotation of 40 and internal rotation of 20, all with pain.  There was no additional loss of function with repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 20% (10% for each hip), analogously coded 5299-5255 (femur, impairment of), citing slight hip disability.  The VA rated the right and left hip conditions 10% each, analogously coded 5299-5255, based on the C&P examination, citing malunion of the femur with slight hip injury.  

The panel noted the NARSUM examination, 3 months prior to separation, ROM measurements of each hip were less than normal, although not low enough to warrant a rating using codes 5251 (thigh, limitation of extension of), 5252 (thigh, limitation of flexion of) or 5253 (thigh, impairment of).  Furthermore, there was no hip ankylosis (code 5250) or hip flail joint (code 5254) of either hip to warrant a higher rating.  The MRIs in August 2008 were normal.  Therefore, although the CI originally had stress changes of both hips, proximate to separation, imaging demonstrated resolution, and by 3 months after separation the CI no longer used any assistive device and had significantly improved ROMs.  Therefore, a 20% rating using code 5299-5255 for a moderate hip disability of either hip was not indicated.  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 bilateral hip condition.  

BOARD FINDINGS:  In the matter of the bilateral hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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:

AR20180015325, 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.

Enclosure