RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04162
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “bilateral snapping hip syndrome” with a disability rating of 0%.

CI CONTENTION:  In addition to the bilateral hip condition, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 2070108	VARD - 20070430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Snapping Hip Syndrome	5099-5024	0%	Ilioinguinal Bursitis, Right Hip	5019	0%	20070329	
			Ilioinguinal Bursitis, Left Hip	5019	0%	20070329	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Snapping Hip Syndrome.  The PEB combined the left and right hip conditions under a single disability rating, analogously coded 5099-5024 and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI reported injuring her hips while attempting to lift and throw another Soldier while doing combatives during basic training.  She heard a loud pop and fell to the ground.  X-rays, bone scan and MRI studies of the bilateral hips were normal.  The CI was diagnosed with snapping hip syndrome on the right, consistent with psoas tendon snapping, and pain along the left ilioinguinal ligament.  The permanent profile listed “chronic hip pain (bilateral snapping hips).”  The commander’s statement indicated the CI was physically incapable of performing the duties of her MOS due to the chronic hip pain condition.  

During the 19 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination revealed palpable snapping with hip flexion, but there was full range of motion (ROM) and normal strength.  The 16 October 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of bilateral hip pain.  Physical examination showed a limp favoring the left leg.  There was pain of both hips at end ROM in any direction.  There was an audible pop of the right hip noted when the CI went to sit up.  The CI pointed to the ilioinguinal ligament as the site of her most significant pain.  

At a physical medicine examination on 6 December 2006, the CI reported constant right greater than left hip pain, aggravated by activity.  Physical examination showed an antalgic gait favoring the left lower extremity.  There was tenderness over the middle of the inguinal ligament area, left greater than right, with increased tenderness with external rotation or flexion of the hip.  The physical medicine examiner agreed with the diagnosis of snapping hip syndrome bilaterally.  Surgical options were discussed but not recommended due to the uncertainty of benefit.  At the physical therapy examination for the MEB on 12 December 2006, 1 month prior to separation, the CI reported bilateral hip pain, aggravated by activity.  Physical examination showed a slightly antalgic gait.  There was a positive test for hip joint pain bilaterally.  There was tenderness of the hips anteriorly in the inguinal ligament area.  Hip motion was abnormal with painful motion noted.  Right hip flexion was 115 degrees (normal 125), extension was 25 degrees (normal 30), abduction was 45 degrees (normal), and external rotation was 45 degrees (normal 60), with painful motion noted.  Left hip ROM in degrees was flexion of 105, extension of 25, abduction of 40 and external rotation of 45, with painful motion noted.  

At the 29 March 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported bilateral hip pain with prolonged walking or standing and when arising from a seated position.  She denied radiating pain, dislocations, subluxations or flare-ups.  She was not taking any medication for the hip pain and there had been no periods of physician prescribed bedrest in the past year.  Physical examination showed a normal gait.  There was no muscle spasm or tenderness.  There was tenderness of the ilioinguinal bursa bilaterally, right greater than left, but testing for hip joint pain was negative bilaterally.  Bilateral hip ROM in degrees was flexion of 125, extension of 30, abduction of 45, and external rotation of 60.  There was no painful motion and there was no additional loss of ROM with repetitive use.  Bilateral hip X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB bundled the left hip with the right hip condition and applied a single 0% rating coded 5099-5024 (tenosynovitis) citing slight loss of motion due to pain.  The VA rated the right hip and left hip conditions 0% each, coded 5019 (bursitis), based on the C&P examination, citing no objective evidence of painful or limited motion of a major joint.  

The panel first considered if the right and left hip conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Both hips were profiled, implicated in the commander’s statement and judged to fail retention standards.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that each of the hip conditions was reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting hip conditions at the time of separation.  There was no limitation of motion of either hip which supported a rating under the diagnostic codes for limitation of thigh extension, flexion or impairment (5251, 5252, 5253).  There was no evidence of hip ankyloses, flail hip joint or femur impairment (5250, 5254, 5255) of either hip to warrant a rating under the respective codes.  However, there was evidence of painful motion with functional loss supporting a 10% rating for each hip (based on §4.59, §4.40 and §4.45).  After due deliberation, and considering all the evidence, the panel recommends a disability rating of 10% for the right hip condition and 10% for the left hip condition, both coded 5099-5024.  

BOARD FINDINGS:  In the matter of the bilateral hip condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting right hip condition rated 10%, and an unfitting left hip condition rated 10%, both coded 5099-5024 IAW VASRD §4.71a.  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 Snapping Hip Syndrome	5099-5024	10%	
Left Snapping Hip Syndrome	5099-5024	10%	
COMBINED	20%	

The following documentary evidence was considered:

AR20190004298, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear Applicant:

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.