RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-04067 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060303

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Surgical Technician, medically separated for “left hip labral tear treated with debridement” with a disability rating of 10%.

CI CONTENTION: “Due to my current condition of Pemphigus Vulgaris, I have suffered from a muscular-skeletal system deterioration of my joints to include: lumbar degenerative disk disease, Bi-lateral hip condition, bilateral knees, wrist, and ankle tendonitis.” 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 - 20050908	VARD - 20060821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Labral Tear Treated with Debridement	5299-5003	10%	Left Torn Labrum with Postoperative Repair with Residual Scar	5316	10%	

20060531	
Pemphigus Vulgaris	Cat III	Pemphigus Vulgaris	7815	NSC		
Left Knee ACL [Anterior Cruciate Ligament] Insufficiency/Patella Femoral Pain Syndrome	
Cat III	Status Post ACL Reconstructive Surgery, Left Knee with Patellofemoral Syndrome	
5257	
10%		
Left Ankle Pain	Cat III	Left Ankle Tendonitis	5271	0%		
Left Thumb Basilar DJD [Degenerative Joint Disease] vs. Dequevain's
Syndrome	
Cat III	
Left Thumb Tendonitis	
5224	
0%		
History of Degenerative Disc Disease, Lumbar Spine	Cat III	Lumbar Strain with Degenerative Joint Disease	5237	20%		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Hip Labral Tear. According to the service treatment record and MEB narrative summary (NARSUM), the CI developed left hip pain in 2004, and an MRI showed a labral tear (cartilage rim of the hip). He underwent left hip arthroscopy in December 2004 for labral repair, but experienced minimal relief of his symptoms. The 7 June 2005 MEB NARSUM examination, 9 months prior to separation, noted CI complaints of left hip pain. Physical examination showed hip range of motion (ROM) was flexion of 110 degrees (normal 125), and external rotation of 45 degrees (normal 60). At an orthopedic consult on 2 September 2005, 6 months before separation, the provider noted tenderness of the left greater trochanter and pain with hip ROM. At a follow-up on 14 October 2005, the CI reported catching, locking and grinding of the hip with exercise. Hip ROM was flexion of 80 degrees, extension of 10 degrees, and normal external rotation.

At the 31 May 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant left hip pain, weakness, and stiffness with limited mobility. He could function during the pain and did not experience any incapacitation. The examiner noted a normal posture and gait, but left hip weakness, tenderness and guarding of movement. Hip flexion was to 100 degrees, extension to 20 degrees (normal 30), abduction to 35 degrees, and external rotation to 50 degrees (normal 60), with painful motion. After repetition, joint motion was additionally limited by 20 degrees due to pain, weakness, lack of endurance and fatigue, which had the major impact. Lower extremity strength, sensation, and reflexes were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left hip condition 10%, analogously coded 5299-5003 (arthritis, degenerative). The VA also rated the left hip condition 10%, but coded 5316 (group XVI: flexion of hip), based on the C&P examination, citing moderate muscle disability. Panel members agreed there was evidence of painful motion with functional loss (based on §4.59, §4.40 and §4.45) supporting a 10% rating, as documented at the VA examination shortly after separation. However, there was no limitation of thigh flexion, extension, or thigh impairment (5251, 5252, or 5253), and no evidence of hip ankyloses, flail hip joint, or femur impairment (5250, 5254, 5255) for a rating under the respective codes. There was therefore no higher than a 10% rating supported under any applicable code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left hip condition.

Contended PEB Conditions: Pemphigus Vulgaris, Left Knee ACL Insufficiency/Patella Femoral Pain Syndrome, Left Ankle Pain, Left Thumb Basilar DJD vs. Dequevain's Syndrome and History of Degenerative Disc Disease, Lumbar Spine. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not noted on limited duty forms or implicated in the non-medical assessment and did not fail retention standards. 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 left hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended pemphigus vulgaris, left knee, left ankle, left thumb and back 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.

DEPARTMENT OF THE NAVY
SECRETARY OF TI!E NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards TO: XXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to
the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.