RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03446
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Military Policeman, medically separated for “arthritis, degenerative left hip” and “arthritis due to trauma left ankle,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “My hip issue is still on going.  I have had a total of 3 left hip surgeries to include dislocation with hardware added.  My hip condition affects my everyday life to include my job.”  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 - 20080708	VARD - 20090318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis, Degenerative Left Hip	5003	10%	Left Hip Surgery	5003	10%	2090114	
Arthritis, Due To Trauma, Left Ankle	5010	10%	Fracture, Left Fibula	5262	20%	20090114	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80% 	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Left Hip.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left hip surgery in April 2007 for debridement of bone spurs and labral tear of the hip joint.  He denied trauma to the hip but felt ankle problems caused him to change his gait which may have caused the hip pain.  Post-surgical neuroimaging of the left hip in November 2007 showed a labral tear, but neuroimaging of the left hip in March 2008 was unremarkable with no fractures or dislocation.  No significant leg length discrepancy was noted.  

The 20 June 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant pain exacerbated by prolonged walking, prolonged standing, lying on his left side, squatting or bending.  The CI reported the hip pain was more severe than the ankle pain.  The 21 May 2008 physical therapy examination showed goniometric left hip range of motion (ROM) with flexion of 50 degrees (normal 125) with pain, extension of 10 degrees (normal) with pain and abduction of 18 degrees.  He walked with a limp favoring the left leg, but muscle strength was 5/5 bilaterally with no weakness in the lower extremities.  There was clicking/snapping of the hip joint.  He was able to cross his legs from left over right.  A diagnosis of left hip osteoarthritis was rendered.  

At the 14 January 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported progressively worse pain with giving way, instability, pain, weakness and decreased speed of joint motion but no dislocation, effusions or locking episodes.  There was warmth and tenderness and flare-ups weekly that were severe, sometimes with no known cause and sometimes with too much walking.  He was employed full time in emergency operations and had lost less than a week from work.  Physical examination showed a normal gait.  Muscle strength was 5/5.  The left leg was slightly shorter than the right with mild effects on daily activities.  Hip ROM showed left flexion to 95 degrees, extension to 20 degrees and abduction to 30 degrees.  He could not cross his left leg over the right but could toe out greater than 15 degrees.  There was pain on motion and following repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 10%, coded 5003 (arthritis, degenerative), citing antalgic gait and slightly limited flexion.  The VA also rated the left hip condition 10%, coded 5003 (arthritis, degenerative), based on the C&P examination, citing painful or limited motion of a major joint.  

The NARSUM examination was more proximate to separation and therefore more probative.  Using the PT ROMs recorded in the NARSUM, the panel determined that the CI’s left hip was essentially non compensable based on the VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253).  However, IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Imaging showed degenerative changes and the left hip pain was recurring and limiting.  There was no higher rating than the 10% adjudicated by the PEB under any applicable code.  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 left hip condition.  

Left Ankle Arthritis due to Trauma.  According to the STR and MEB NARSUM, the CI underwent left ankle surgery in April 2007 to repair fractures of his left tibia and ankle.  He developed pain due to osteoarthritis.  The MEB NARSUM examination noted complaints of intermittent left ankle pain with prolonged standing and walking and an inability to run.  Physical examination showed left ankle ROM of dorsiflexion to 20 degrees (normal) and plantar flexion of 45 degrees (normal) without pain, but there was crepitus with motion.  He was neurovascularly intact and provocative testing showed a stable ankle.  Left ankle X-rays from June 2008 of the distal fibula showed plate and screws intact with joint space narrowing and osteophyte seen on the medial aspect of the ankle joint.  A diagnosis of left ankle osteoarthritis due to trauma was rendered.  

At the C&P examination, the CI reported his condition progressively worsened with crepitus, tenderness and pain at rest.  He was able to walk a quarter mile and used no assistive devices.  Physical examination showed a normal gait.  Both the right and left shoes showed increased wear of the outside edge of the heel.  There was no instability, but there was pain with motion and ROM showed left dorsiflexion of 10 degrees and plantar flexion of 25 degrees.  Right leg length from greater trochanter was 36.25 inches and the left leg from the greater trochanter was 36 inches.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5010 (arthritis due to trauma), citing painful motion.  The VA rated the left ankle condition 20%, coded 5262 (impairment of tibia and fibula), based on the C&P examination, citing malunion of the tibia and fibula with moderate knee or ankle disability.  

The panel noted the underlying cause for the ankle impairment was residuals of a fracture of the fibula and considered rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula and ankle), however there was no mal union or nonunion to assign a rating.  The panel agreed with the PEB that there was evidence of painful motion with functional loss and therefore, IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted.  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 left ankle condition.  

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

Exhibit A.  DD Form 294, dated 20170324, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008990, 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