RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03764
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic pain left hip” with a disability rating of 20%.

CI CONTENTION:  Left hip 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 - 20060323	VARD - 20091109*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Hip	5099-5003	20%	Left Hip Fracture Status Post Surgical Fixation	5252	10%	20060426	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
*VA administrative delay in rating.  

ANALYSIS SUMMARY:  

Chronic Pain Left Hip.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left hip surgery in July 2005 for a nondisplaced fracture after an obstacle course injury earlier that month.  Hip X-rays taken in October 2005 showed a well-healed femoral neck with three screws traversing the fracture site.  Despite physical therapy and activity modification, the pain continued and the CI was unable to return to training.

The 1 December 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of left hip pain with difficulty walking and an occasional limp.  Physical examination revealed tenderness over the left greater trochanter and a well-healed incision.  Hip range of motion (ROM) was bilaterally symmetric, with goniometrically measured left hip flexion of greater than 90 degrees (normal 125), abduction of 60 degrees (normal 45), external rotation of 60 degrees (normal 60) and internal rotation of 30 degrees (normal 40).  

During the 26 April 2006 VA Compensation and Pension (C&P) examination, 6 days before separation, the CI reported pain from a femoral neck stress fracture.  Physical examination showed a healed surgical incision, left hip tenderness, and normal posture and gait.  Left hip ROM was to the VASRD normal limits for each plane, with painful motion.  Although there was pain, fatigue, and lack of endurance following repetition, there was no ROM loss.  Hip X-rays showed orthopedic nails in good position and a healing femoral neck fracture with callous formation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 20%, analogously coded 5099-5003 (degenerative arthritis), citing “marked/constant” pain and application of the US Army Physical Disability Agency pain policy.  The VA rated the left hip condition 10%, coded 5252 (thigh, limitation of motion), based on the C&P examination, citing painful motion.  Panel members agreed there was no compensable limitation of flexion, extension, or thigh impairment (codes 5251, 5252, or 5253); or nonunion, loose motion, or false joint to meet criteria for a higher 30% rating for “marked” knee or hip disability under code 5255 (femur impairment).  There was therefore no higher rating than 20% available under any applicable VASRD code.  After due deliberation, considering all 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.  

BOARD FINDINGS:  In the matter of the left 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:

PD-2017-03764

AR20190011730, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

	PD-2017-03764