RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04102
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, AH-64 Attack Helicopter Repairer, medically separated for “right hip pain” with a disability rating of 0%.

CI CONTENTION:  In addition to the right hip condition, the CI requested review of the bilateral knee condition.  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 - 20061115	VARD - 20070530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	0%	Tendonitis of the Right Hip	5024-5252	10%	20070417	
Bilateral Knee Pain	Not Unfitting	Right Knee Tendonitis	5024	10%	20070417	
		Left Knee Tendonitis	5024-5261	10%	20070417	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in April 2006 without trauma or injury.  A bone scan and MRI of the right hip were negative.  The 24 October 2006 physical therapy range of motion (ROM) examination, 1 month prior to separation, showed flexion of 100 degrees (normal 125), extension of 8 degrees (normal 20) and abduction of 22 degrees (normal 45).  Gait, painful motion and deformity were not addressed.  

The 27 October 2006 MEB NARSUM examination, 1 month prior to separation, noted complaints of constant right hip pain, localized to the greater trochanteric area.  He was unable to run, participate in sports or do prolonged sitting or standing.  Standing and walking were restricted to about 15 minutes before he developed severe pain.  Physical examination showed tenderness to the greater trochanteric area, but full active ROM of the right hip.  There was pain with resistance to hip abduction, but muscle strength was 5/5 and the neurologic examination was normal.  

At the 17 April 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported pain, instability, giving-way, stiffness and weakness in the right hip.  He denied dislocation or subluxation, but noted flare-ups daily.  Physical examination showed an antalgic gait.  The ROM evaluation showed flexion to 45 degrees, extension to 25 degrees and abduction to 30 degrees; there was pain with motion and the joint was tender.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing minimal and intermittent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the right hip condition 10%, dual coded 5024-5252 (tenosynovitis causing limitation of thigh flexion), based on the C&P examination, citing limitation of motion.  

The panel determined the CI’s right hip was essentially non-compensable based on the VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253).  However, IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  Despite conservative therapy, the right hip pain was recurring and limiting.  Examinations showed pain with resistance to hip abduction.  The panel considered other VASRD codes for a higher rating, but there was insufficient evidence of a significantly disabling hip condition to justify a rating greater than 10%.  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 5099-5003.  

Contended PEB Conditions:  Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The bilateral knee pain was profiled S3 and judged to fail retention standards.  X-rays showed mild increased uptake in the knees but the NARSUM noted improvement in the knee pain.  The physical therapy examination in October 2006 showed right and left knee flexion of 141 degrees and extension of 0 degrees, without pain.  The condition was not implicated in the commander’s statement or the NARSUM as significantly interfering 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 knee conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71.  In the matter of the contended bilateral knee condition, the panel recommends no change from the PEB determination as not unfitting.  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	
Right Hip Pain	5099-5003	10%	
The following documentary evidence was considered:

AR20190004287, XXXXXXXXXX

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Dear XXXXXXXXXX:

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.