RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04757
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right hip pain” and “low back pain,” rated 10% each, with a combined disability rating of 20%. 

CI CONTENTION:  “5299 5255 Right Hip Pain 10%/Lumbar Sacral Strain 20%.”  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 - 20080606	VARD - 20090428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5299-5255	10%	Right Hip Stain	5252	0%	20081016	
Low Back Pain	5299-5237	10%	Low Back Strain	5237	10%	20081016	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right hip pain began in March 2006 without a history of trauma.  A pelvic bone scan on 1 May 2006 revealed no abnormalities, but an MRI in December 2006 showed developmental right hip dysplasia.  Orthopedics diagnosed osteoarthritis in January 2008.  

At the 28 April 2008 MEB NARSUM examination, 5 months prior to separation, the CI’s chief complaint included right hip pain.  The physical examination (PE) revealed painful and decreased range of motion (ROM).  Physical therapy (PT) ROM measurements taken on 17 March 2008 showed flexion to 80 degrees (normal 125), extension to 7 degrees (normal 20) and abduction to 36 degrees (normal 45).  Additionally, the provider noted that the CI was unable to cross his legs.  

At the 16 Oct 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant right hip pain rated at 5/10.  The examiner documented a normal gait, and right hip ROM was full in all directional parameters except for a 5-degree loss in flexion, measured at 120 degrees, with painful motion; the CI was able to cross his legs. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5299-5255 (femur; impairment of), citing slight hip disability.  The VA rated the right hip condition 0%, coded 5252 (thigh; limitation of flexion), based on the C&P examination, citing the absence of limited flexion to 45 degrees (minimum rating under 5252).  Members agreed that the VA examination held the greatest probative value due to its proximity to separation, and that there was insufficient limitation of motion to support a minimum rating under a ROM code, and no evidence of ankylosis, or malunion/non-union of bone resulting in at least a slight disability of the hip.  While no positive impairment rating was supported, IAW DoDI 6040.44, the panel may not recommend a rating lower than that adjudicated by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the right hip condition. 

Low Back Pain (LBP):  According to the STR and MEB NARSUM, the CI’s LBP began in February 2006 without a history of trauma.  Throughout 2006 and 2007, STR entries cited intermittent flare-ups of LBP lasting either days, weeks, or months without any inciting events.  At the 28 April NARSUM examination, 5 months before separation the CI’s chief complaint included LBP described as constant burning and aching, and aggravated by “prolonged sitting, walking or carrying things.”  The PE revealed painful and decreased spinal ROM.  At the PT ROM study on 17 March 2008, forward flexion was to 75 degrees (normal 90) and combined ROM was200 degrees (normal 240), with no tenderness noted.

At the 4 June 2009 C&P examination, 1 month after separation, the CI reported intermittent LBP made worse by sudden movements, walking or standing.  The PE revealed a normal gait.  Thoracolumbar ROM was painful and decreased, with forward flexion to 80 degrees and a combined ROM of 230 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing limited ROM.  Utilizing the same code, the VA also rated the back condition 10%, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes that would provide for a higher rating under that formula.  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 low back condition.   

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

 [AR NUMBER], XXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX:

	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.

Sincerely,					      
Enclosure