RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03287
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Practical Nurse, medically separated for “chronic right hip pain” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20050114	VARD - 20050418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5019	0%	Right Hip Bursitis	5019-5251	10%	20050311	
[Right] DeQuervain’s Tenosynovitis	Not Unfitting	Right Wrist (Dominant) DeQuervain’s Tenosynovitis	5099-5024	10%		
		Right Cubital Tunnel Syndrome	8599-8515	10%		
[Right] Dorsal Wrist Ganglion		Right Wrist Ganglion Cyst	5015-7819	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in August 2002 during advanced individual training without trauma.  MRI of the pelvis was normal and repeated imaging, including hip X-rays and bone scan in 2004, were also normal.  The CI was diagnosed with trochanteric (hip) bursitis, but surgery was not indicated.  The orthopedic examination on 4 November 2004, showed a normal gait.  There was tenderness of the hip with full, but painful motion and no weakness or instability.  

At the 8 November 2004 MEB NARSUM examination, 5 months prior to separation, the CI complained of constant right hip pain.  Physical examination showed tenderness of the greater trochanter.  Range of motion (ROM) testing of the right hip showed flexion of 130 degrees, with knee flexed and 90 degrees, with knee extended (normal 125), extension was 15 degrees (normal 30), abduction was 45 degrees (normal) and external rotation was 45 degrees (normal 60).  There was no tenderness with internal or external rotation.  A chiropractic examination on 7 January 2005, 3 months before separation, showed “full” ROM with painful flexion and extension.  

At the 11 March 2005 VA Compensation and Pension (C&P) examination, 3 weeks before separation, the CI reported right hip bursitis.  Physical examination showed normal posture and gait.  The right hip ROM study showed flexion of 130 degrees, extension of 10 degrees, abduction of 45 degrees and external rotation of 45 degrees, with pain and stiffness in all planes of movement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, coded 5019 (bursitis), citing full ROM.  The VA rated the right hip condition 10%, dual coded 5019-5251 (bursitis-limitation of extension) based on the C&P examination, citing functional loss due to pain.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of thigh flexion or extension or thigh impairment (5251, 5252 and 5253).  However, a 10% rating was supported for bursitis with painful limited motion of a single major joint.  There was no evidence of hip ankyloses, flail hip joint, or femur impairment (5250, 5254, 5255) for a rating under the respective codes.  There was therefore no higher rating than 10% supported under any applicable VASRD §4.71a 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 right hip condition, coded 5019.  

Contended PEB Conditions:  DeQuervain’s Tenosynovitis and Dorsal Wrist Ganglion.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither condition was profiled, implicated by the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel recommends a disability rating of 10%, coded 5019 IAW VASRD §4.71a.  In the matter of the contended DeQuervain’s tenosynovitis and dorsal wrist ganglion, 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	
Chronic Right Hip Pain	5019	10%	

The following documentary evidence was considered:

AR20190002238, 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.

Enclosure