RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04008
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061017

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “chronic left 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 - 20060628	VARD - 20071004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain	5099-5003	0%	Left Hip Osteoarthritis and Degenerative Joint Disease	5010-5252	10%	20070531	
Anxiety Disorder	Not Unfitting	Posttraumatic Stress Disorder	9411	50%	20070511	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Chronic Left Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s hip condition began in 2003 with an insidious onset after prolonged weight bearing with load bearing equipment and full battle gear. The 2000 military entry physical showed no evidence of hip disease and she subsequently deployed twice to Iraq. She was diagnosed with congenital hip dysplasia on 5 November 2005 by X-ray, which showed severe degenerative changes as well as moderated cystic changes of the femoral head and acetabulum.

The 13 February 2006 MEB NARSUM examination, 8 months prior to separation, noted CI complaints of unbearable pain that had worsened since her first deployment. The condition was aggravated by high impact activity on the hip joints, and weight bearing exercises using the lower body were also painful. The only treatment that relieved her condition was rest, and she reported needing at least 2 days of inactivity to recover from the pain brought on by walking for a physical fitness test. Physical examination of the lower extremity showed no hip tenderness, but there was left groin pain with passive internal/external rotation as well as straight leg raises. Left hip range of motion (ROM) showed flexion to 90 degrees (normal 125) and abduction to 30 degrees (normal 45). Hip X-rays showed congenital left hip dysplasia with moderate-to-severe joint degeneration, collapse of the femoral head, and subchondral sclerosis and cyst formation on both sides of the joint. The 11 April 2006 MEB addendum showed left hip flexion to 90 degrees, extension to 10 degrees (normal 20) and abduction to 35 degrees, with moderate pain in all planes during the ROM measurements.

At the 31 May 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported left hip pain, rated at 1/10, which was exacerbated by activity and alleviated with rest. She had difficulty with squatting and getting in or out of a car. She was also pregnant and not receiving any treatment. Physical examination showed normal posture and gait. Left hip flexion was to 115 degrees, and after repetitive exercise, to 120 degrees; abduction was to 22 degrees, and after repetitive exercise, to 28 degrees. The CI completed four shallow knee bends and after ROM measurements of the knees, the examiner noted that she began crying, and stated that she had “forgotten how painful her hip could be.” She had to rest for 10 minutes before she could finish the examination, and said that the hip pain had been exacerbated by the knee measurements (rather than repetitive movement). Hip X-rays from March 2007 showed possible osteonecrosis (bone death).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the hip condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing decreased ROM, not independently ratable but service aggravated after deployment to Iraq. The VA rated the hip condition 10%, dual coded 5010-5252 (arthritis, due to trauma, substantiated by X-ray findings - thigh, limitation of flexion of), based on the C&P examination, citing limited, painful motion and X-ray findings of degenerative changes. Although there were no compensable hip/thigh ROM limitations under codes 5250-5253, panel members agreed that IAW VASRD §4.40, §4.45, and §4.59, a 10% rating was warranted for 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. 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 hip condition, coded 5099-5003.

Contended PEB Condition: Anxiety Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the hip condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the contended anxiety disorder, the panel agrees it cannot recommend it 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Hip Pain	5099-5003	10%	

	PD-2017-04008

XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXX

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. 

	PD-2017-04008