RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04628
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “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 - 20051221	VARD - 20070223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain	5099-5003	0%	Left Hip Stress Fracture…	5252	30%	20060419	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left hip condition began in August 2005 during basic combat training, and he underwent a left mid-cervical femoral neck stress fracture fixation by cannulated screw.  In October 2005, X-rays revealed 3 left femoral neck screws with some sclerosis, but no fracture line.  A physical therapy examination on 30 November 2005, 2 months before separation, revealed limitation of left hip abduction and external rotation to 30 degrees (normal 45).  The therapist noted all motions on the left were limited by pain.   The 2 December 2005 MEB NARSUM examination, 1 month prior to separation, noted CI complaints of pain at the screw heads, rated at 4-6/10.  She reported pain 80% of the time during her waking hours and about 50% at night approximately 5 nights a week. Physical examination showed a non-antalgic gait, full hip range of motion, decreased sensation at the posterolateral left thigh, and a well-healed incision.  

At the 19 April 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI complained of daily left hip pain and discomfort, and reported doing daily stretching and strengthening exercises at the gym; she was able to use an elliptical machine for 15-20 minutes and am exercise bike with no resistance.  The examiner noted an antalgic gait and that the left lower extremity was 1.5 cm shorter than the right; the CI could not stand evenly on both feet without a shoe lift.  There was 4/5 hip muscle strength with pain on abduction and internal rotation, and diffuse left hip tenderness.  Left hip abduction was limited to 25 degrees, extension to 18 degrees (normal 20), flexion to 112 (normal 125), and external rotation to 23 degrees.  There was pain in all planes of motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the left hip condition 30%, coded 5252 (thigh, limitation of flexion) based on the C&P examination, citing femur malunion and marked hip disability.  Members agreed that there was no limitation of flexion or extension which warranted ratings under diagnostic codes 5252 or 5251.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no fracture, nonunion or malunion of the femur to support consideration under 5255.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the left hip condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left hip condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter for dissent recommends modification to 20% and did not elect to submit a minority opinion.  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	
Left Hip Pain	5099-5003	10%	

The following documentary evidence was considered:

AR20190005376 XXXXXXXXXX

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 and to the counsel you listed on your application; [name and address].