RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04645
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aviation Operations Specialist, medically separated for “left hip pain with trochanteric bursitis, internal snapping hip syndrome, and iliotibial band syndrome” with a disability rating of 10%.

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 - 20080415	VARD - 20090618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain…	5019	10%	Left Hip Strain (Claimed as Fracture)	5014	10%	20090331	
History of Stress Reaction Changes consistent with Early Stress Reaction Fracture of Left Inferior Pubic Ramus	Not Unfitting	No VA Placement	
History of Right Femoral Neck Stress Reaction Fracture	Not Unfitting	Right Hip Strain	5014	10%	20090331	
History of Low Back Pain	Not Unfitting	No VA Placement	
History of Left Ankle Sprain	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	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 pain began following falls in basic training and in January 2007.  A bone scan indicated increased uptake in the left inferior pubic ramus consistent with an early stress fracture, but an MRI showed no abnormalities on the left side.  Follow-up X-rays in September 2007 revealed “no acute or chronic abnormalities.”  Physical therapy, injection and activity restriction did not resolve the left hip pain, and surgery was not indicated.

The 21 March 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of chronic left hip pain.  Physical examination showed a normal gait and referenced the 13 March 2008 DD Form 2808 evaluation, which documented full, painful left hip range of motion (ROM) and tenderness.  At the 26 March 2008 MEB physical therapy evaluation, left hip ROM testing showed flexion to 95 degrees (normal 125), abduction to 55 degrees (normal 45), and external rotation less than 15 degrees (normal 45); the CI was able to perform adduction to crossed leg position with painful motion, and there was no change in ROM due to repetition.

At the 31 March 2009 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported chronic left hip pain elicited by activity.  She endorsed giving way, lack of endurance, locking and popping.  Physical examination revealed normal posture and gait and left hip tenderness without guarding or other abnormal findings.  Left hip ROM was full with no loss of ROM after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 10%, coded 5019 (bursitis), citing hip ROMs and flare-ups rated as limited motion.  The VA rated the left hip condition 10%, coded 5014 (osteomalacia), based on the C&P examination, citing painful or limited motion. Members first clarified that the MEB/PEB’s diagnoses of left hip bursitis, left internal snapping hip syndrome, and left iliotibial band syndrome are intrinsic to the rated left hip pain condition and a separate rating cannot be supported without pyramiding IAW VASRD §4.14 (more than one rating based on the same impairment is prohibited); thus, they are appropriately subsumed under the same rating.  The panel agreed that there was no compensable limitation of hip motion under codes 5250 thru 5253.  However, there was clear objective evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45), recorded on the MEB NARSUM examination to warrant a 10% rating.  Codes 5019 and 5255 (femur, impairment) only warrant a 10% rating which offers no rating advantage to the CI.  After due deliberation, considering all of 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 left hip condition.  

Contended PEB Conditions:  History of: Stress Reaction Changes Consistent with Early Stress Reaction Fracture of Left Inferior Pubic Ramus; Stress Reaction Fracture, Right Femoral Neck; Low Back Pain; and Left Ankle Sprain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The CI received an L3 profile which indicated “chronic hip, back and leg pain” during the ongoing MEB.  The commander’s statement did not implicate any of the contended conditions.  Additionally, there was no performance-based evidence from the record that the contended 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 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 history of stress reaction changes consistent with early stress reaction fracture of left inferior pubic ramus; history of stress reaction fracture, right femoral neck; history of low back pain; and history of left ankle sprain 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.

The following documentary evidence was considered:

[AR NUMBER], XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.

Enclosure