RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03878 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20041014

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Heavy Wheeled Vehicle Mechanic, medically separated for “chronic pain, right hip, right thigh and right knee” with a disability rating of 20%.

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 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 - 20040914	VARD - 20050825	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Pain, Right Hip, Right Thigh, and Right Knee (Includes MEB Chronic Pain Syndrome Diagnosis)	

5099-5003	

20%	Residuals, Right Pelvic and Hip Fractures	5299-5252	10%	20050329	
			Internal Derangement Right Knee	5260	10%	20050329	
			Right Calf …	5311-7804	10%	20050329	
			Scar, Right Flank and Hip	7804	10%	20050329	
			Scar, Right Knee …	7804	10%	20050329	
			No Separate Right Thigh VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Chronic Right Hip, Right Thigh, and Right Knee Pain (Includes MEB Chronic Pain Syndrome Diagnosis). According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a motor vehicle accident (MVA) in August 2003 with multiple pelvic fractures (open right iliac wing, bilateral inferior pubic rami, and left superior pubic root), a right calf laceration, and degloving of the skin overlying the right iliac crest (hip, lower back and proximal thigh) due to being dragged. He was hospitalized and underwent multiple surgical procedures. During rehabilitation he had recurring right hip pain, fell, and was diagnosed with a right anterior cruciate ligament (ACL) tear. In March 2004, he underwent a right ACL repair (graft), medial meniscus debridement, and removal of glass from the right thigh. He was subsequently diagnosed with neuralgia in the thigh and peroneal nerve (knee and below) neuropathy, and underwent right calf scar and muscle fascia revision in July 2004; however, he continued to have

right hip and thigh neuropathic pain (with inability to wear utility uniform over the scarred area), right hip/flank and back pain, and right knee pain.

The 9 August 2004 MEB NARSUM examination, 2 months before separation, noted CI complaints of chronic right hip, thigh, knee, and leg pain. Physical examination showed he was somewhat uncomfortable at times with prolonged sitting, and a bit stiff with transfers. The skin was remarkable for extensive scarring over the right pelvic area (approximately 20 cm x 18 cm) from the iliac crest to below the greater trochanter of the right hip with several areas of thin, violaceous contracture that were exquisitely tender to light touch. There were additional less tender hypertrophic contractures (5cm and 10cm) more distally, and also a 12-15 cm x 12cm horizontal scar at the proximal right calf which was less tender and allowed more mobility since a scar revision by a plastic surgeon. Right hip range of motion (ROM) measurements showed flexion to 70 degrees (normal 125) and abduction to 43 degrees (normal 45), with pain. Right knee flexion was to 110 degrees with pain and crepitus. The physician stated, “Pain Rating: Moderate and constant and 8/10 and interferes with his activities of daily living, interferes with his ability to sleep and his interpersonal relationships.” Records indicated the CI underwent a right hip area scar excision and muscle flap graft in September 2004, 1 month before separation. There was some post-operative infection which resolved with conservative treatment.

At the VA Compensation and Pension (C&P) examinations on 17 and 29 March 2005, 5 months after separation, as well as a C&P scar examination on 1 April 2005, the CI reported back (right flank), hip, knee and leg pain, and painful scarring due to the MVA. He had flare-ups and the right knee gave way. The examiner noted that he entered the examination room with a very halting gait because of the scars and sensitivity on the right side of his body. Skin examinations revealed scarring of the back and right knee, calf, and hip, with multiple scars which were very tender on palpation as well as change in position. There was right lower leg weakness attributed to pain, right hip and pelvis tenderness, and right thigh atrophy of 1 inch in circumference. The right- sided scarring was very sensitive to touch and change in position. The tender right hip and flank scarring was 28 cm x 35 cm, inflamed, elevated/depressed, and adherent to underlying tissue, with tissue loss of 8 x 9 cm. Bilateral knee flexion was from 0-150 degrees with increased pain during repetition, but no patellar crepitus or grinding. Right hip flexion was to 110 degrees, extension to 0 degrees, and external rotation to 30 degrees (normal 60). Repetitive motion increased the pain, but there was no fatigue, weakness, lack of endurance or incoordination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB bundled and rated the chronic right knee, thigh, and knee pain as well as MEB diagnosis #4 of chronic pain syndrome at 20%, analogously coded 5099-5003 (degenerative arthritis) citing the US Army Physical Disability Agency pain policy. The VA rated the right hip/pelvis condition 10%, analogously coded 5299-5252 (thigh, limitation of flexion) and the right knee condition 10%, coded 5260 (leg, limitation of flexion), citing painful motion; the right hip and flank scar 10%, coded 7804 (scars, superficial, painful on examination) and the right knee scar 10%, coded 7804, citing painful scar; and the right calf condition 10%, dual coded 5311-7804 (Group XI muscle function- scars, superficial, painful on examination), citing tissue loss and  painful scar.

Panel members first considered whether the multiple bundled conditions, having been de- coupled from the combined PEB adjudication under the USAPDA pain policy, remained separately unfitting. In this case the chronic right hip, thigh, and knee pain were considered to fail retention standards (separately listed on the MEB with “chronic pain syndrome” diagnosis), were implicated by the NARSUM and the commander’s statement (right knee, thigh, and leg pain), and were profiled (right thigh, leg and hip pain and chronic pain). Therefore each extremity condition (right hip, right thigh, and right knee) was considered reasonably justified as separately unfitting. The commander did not implicate any mental health condition or symptoms, and the PEB did not specifically list “chronic pain syndrome” in their narrative, but instead indicated “chronic pain.” There was insufficient evidence of a separately unfitting chronic pain syndrome as a mental

health disorder, and any pain from the separately unfitting extremity conditions was considered in their aforementioned separate ratings.

The panel agreed that the right hip condition warranted a 10% rating for painful motion as supported by the NARSUM and VA examinations. The right knee warranted a 10% rating for painful motion on the VA examination or for symptoms following meniscal surgery (analogous code 5259) on the NARSUM. When deliberating over rating the right thigh condition under neurologic analogous codes for 8620 (sciatic neuritis) or skin criteria (7804 or 7801-deep scars), panel members agreed that although scars are not usually considered separately unfitting, in this case there was clear evidence of thigh pain with hypersensitivity interfering with uniform wear. Thus, the panel agreed that the right thigh condition warranted a 10% rating, dual coded 8620- 7804. The panel determined that the right knee scar tenderness was not separately unfitting as the unfitting knee was rated 10% for pain and the knee scar did not separately (or in combination) interfere with duty performance. 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 5299-5252, a disability rating of 10% for the right knee condition, coded 5259-5260, and a disability rating of 10% for the right thigh condition, coded 8620-7804.

BOARD FINDINGS: In the matter of the right hip, knee and thigh conditions, the panel recommends that each extremity condition be separately adjudicated as follows: an unfitting right hip condition coded 5299-5252 and rated 10%; an unfitting right knee condition coded 5259-5260 and rated 10%; and an unfitting right thigh condition coded 8620-7804 and rated 10%, with the right hip and knee IAW VASRD §4.71a and the right thigh IAW VASRD §4.124a. In the matter of the chronic pain syndrome, the panel agrees that it cannot recommend a finding of unfit for additional disability rating. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Hip Pain	5299-5252	10%	
Chronic Right Knee Pain	5259-5260	10%	
Chronic Right Thigh Pain	8620-7804	10%	
	COMBINED	30%	

PD-2017-03878 

AR20200000357, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

PD-2017-03878