RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04226
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050916

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic right hip pain” with a  disability rating of 10%.

CI CONTENTION: “Have continue suffering with pain and complications from the injuries. Injuries were not properly diagnosed and treated originally by the Army.”  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 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 - 20050713	VARD - 20060302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain	5099-5003	10%	Chronic Right Hip Pain	5099-5014	10%	20051119	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Right Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained an injury in November 2003 while lifting a heavy generator which then fell onto his upper thighs, pelvis and hips. He developed pain over the next week, underwent orthopedic evaluation, and was treated with temporary profiles and medications without relief. In January 2005, he had a right hip arthroscopic joint debridement, but was subsequently unable to move without significant pain. Hip X-rays were normal, but an MRI showed a possible anterior labral tear versus slight labral recess. The 16 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of right hip pain precipitated by prolonged standing, sitting, walking (with crutches) and climbing stairs; small movements, positional adjustments and narcotic pain medication provided some relief. The examiner noted tenderness with full passive range of motion (ROM), and pain with internal and external rotation.

At the 19 November 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant pain that flared up with activities and exposure to cold

weather. He used narcotic pain medication daily, had missed around 45 days of work in the previous year, and had difficulty performing activities of daily living due to severe pain when bending and flexing the right hip. He had not worked since discharge, but was seeking employment in the medical field. The examiner documented a significant limp on the right side with the hip and knee slightly flexed, and the CI sat with his right lower extremity stretched out because of hip pain when trying to sit normally. Examination was complicated by severe hip and ileum pain, but there was there was no swelling or tenderness. Measured ROM showed flexion to 90 degrees (normal 125) with severe pain at 50 degrees. Extension was to 10 degrees (normal
20) and abduction was to 40 degrees (normal 45). There was painful motion in all planes that resulted in limitation of motion. The examiner noted a discrepancy between clinical findings and normal X-rays of the pelvis and hips, and was unable to determine the cause of the severe pain; the CI was referred to a pain medicine specialist.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing pain. The VA also rated the right hip condition 10%, but analogously coded 5099-5014 (osteomalacia), based on the C&P examination, citing pain limited motion. Panel members noted that while there was no compensable hip limitation of motion recorded in at the MEB or VA examinations, there was documentation of functional limitation due to painful motion warranting a 10% rating IAW VASRD §4.40, §4.45, and §4.59. The panel considered other VASRD hip and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher rating than the 10% adjudicated by the PEB. 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.

BOARD FINDINGS: In the matter of the right hip condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication. 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.

The following documentary evidence was considered:

2	PD-2017-04226

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20200000158, XXXXXXXX

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.