RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04002
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Information Technology Specialist, medically separated for “loss of right thigh extension due to snapping hip syndrome ” and “painful scar,” rated 10% each, with a combined 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’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 - 20080229	VARD - 20090206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Loss of Right Hip Extension	5251	10%	Right Hip Tendonitis…	5024-5251	10%	20081022	
Painful Scar	7804	10%	No VA Placement	
Plantar Fasciitis	Not Unfitting	Plantar Fasciitis	5299-5276	0%	20081022	
Acquired Flat Foot Deformity, Right Foot	Not Unfitting	No VA Placement	
Orthostatic Proteinuria	Not Unfitting	Orthostatic Proteinuria	7599-7500	NSC	20081022	
Nontoxic Multinodular Goiter	Not Unfitting	Enlarged Thyroid	7902	0%	20081022	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Loss of Right Thigh Extension.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right hip condition began after a motor vehicle accident in September 2002, and was aggravated by increased physical training in September 2005.  An arthrogram in July 2006 noted a superior labral tear and mild acetabular retroversion, and in September 2006 she had right hip surgery with debridement and iliopsoas tendon release.  There were complications of hematoma and lateral femoral cutaneous nerve damage, and she continued hip pain and limitations.  

The 15 January 2008 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of daily right hip pain, weakness, locking and giving way.  Physical examination showed she was able to heel-toe and tandem walk without difficulty.  Right hip range of motion (ROM) after repetition was:  flexion of 90 degrees (normal 125), extension of 2 degrees (normal 30), external rotation of 32 degrees (normal 60) and abduction of 36 degrees (normal 45) with the ability to toe-out at least 15 degrees.  There was painful limitation of motion.  

At the 22 October 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right hip pain.  Physical examination showed painful right hip ROM with flexion to 125 degrees, extension to 25 degrees, abduction to 40 degrees, external rotation to 50 degrees, and that the CI could toe-out greater than 15 degrees.  With repetition, there was no additional loss of motion secondary to pain, weakness, or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5251 (thigh, limitation of extension), citing loss of extension to 2 degrees after repetition.  The VA also rated the right hip condition 10%, but analogously coded 5024-5251 (tenosynovitis-thigh, limitation of extension), based on the C&P examination, citing painful or limited motion of a major joint.  Panel members noted that the NARSUM documented compensable limited hip extension to 5 degrees supporting a 10% rating under code 5251.  All examinations also documented sufficient evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45) to warrant a 10% rating.  There was insufficient limitation motion for alternative or higher rating under other limitation of motion codes (5250, 5252, or 5253, or 5254), and no femur malunion for alternative rating under code 5255 (femur, impairment of).  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 right hip condition.  

Painful Scar.  According to the STR and MEB NARSUM, the CI’s inguinal scar condition began following right hip surgery in September 2006.  The MEB NARSUM examination noted complaints of inguinal scar pain, and the examiner indicated there was tenderness over the 5-cm anterior right hip scar preventing wear of protective gear.  The C&P examination did not report any skin complaints or document scars.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the painful scar condition 10%, coded 7804 (scars, superficial painful on examination), citing marked tenderness.  There were not at least three scars that were unstable or painful to support the next higher rating.  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 painful scar condition.  

Contended PEB Conditions:  Right Foot Plantar Fasciitis, Right Foot Acquired Flat Foot Deformity, Orthostatic Proteinuria and Nontoxic Multinodular Goiter.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Right foot plantar fasciitis was profiled and failed retention standards, but none of the other conditions were profiled and did not fail retention standards.  The commander’s statement implicated the right hip condition and “other medical issues” without further details. There was no performance-based evidence from the record that any of the 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the scar condition and IAW VASRD §4.118, the panel recommends no change in the PEB adjudication.  In the matter of the contended right foot plantar fasciitis, right foot acquired flat foot deformity, orthostatic proteinuria and nontoxic multinodular goiter conditions, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

:

PD-2017-04002

AR20190012011, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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-2017-04002