RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04661
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Air Defense Tactical Operations Center Operator, medically separated for “bilateral hip pain from impingement syndromes,” rated 10% for each hip, with a combined disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20081009	VARD - 20090326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hip 	5099-5003	20%	Left Hip Nerve Impingement	8599-8520	10%	20081114	
			Right Hip Nerve Impingement	8599-8526	10%	20081114	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bilateral Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral hip condition began in October 2006 when a bookshelf fell on him resulting in a crush injury.  He was diagnosed with a right femoral acetabular impingement and underwent a surgical hip dislocation and acetabular femoral neck decompression on 17 July 2007; post-operatively, his pain improved but continued.  At an orthopedic appointment on 17 September 2007, the CI complained of left hip pain, and the provider noted tenderness over the left greater trochanter and trochanteric bursa, and an audible snap of the psoas with provocative maneuvers.  There was limitation of internal rotation with flexion of the left hip as well as a positive impingement sign.  A surgical release of the left psoas tendon was recommended upon full recovery from the right hip surgery.  On 11 July 2008, the CI had an arthroscopic labral debridement and osteoplasty of the femoral head/neck junction and psoas.  At an orthopedic follow-up on 8 September 2008, the provider noted reports of continued lateral left hip pain but resolution of the snapping.  

The 8 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent bilateral hip pain with left buttock muscle spasm.  Range of motion (ROM) measurements, in degrees, showed right hip flexion to 80, internal rotation to 20, and external rotation to 40.  Left hip flexion was to 90, internal rotation to 25, and external rotation to 45. Both hips showed positive impingement signs and pain at ROM endpoints.

At the 14 November 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported bilateral hip pain.  Physical examination showed a slight limp due to hip pain, and although bilateral hip ROM was normal, there was pain and stiffness with motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each hip condition 10%, analogously coded 5003 (degenerative arthritis, citing limitation of motion.  The VA also rated each hip 10%, but analogously coded 8520 (sciatic nerve mild incomplete paralysis) for the left, and 8526 for the right (femoral nerve mild incomplete paralysis), based on the C&P examination, citing mild physical impairments due to nerve impingement.  Members agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5252, 5251).  However, there was evidence of bilateral painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for each hip.  The panel also considered a rating under codes 8520 and 8526; however, there was no disturbance of movements or other evidence to support a 20% rating for either hip.  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 bilateral hip pain conditions. 

BOARD FINDINGS:  In the matter of the bilateral hip pain and IAW VASRD §4.71a, 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:

, 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