RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04778
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3, Trainee, medically separated for “chronic bilateral hip and leg pain” with a disability rating of 10%. 

CI CONTENTION:  “Army issued me 20%.  Veterans Affairs helped me afterwards.”  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 - 20040309	VARD - 20041014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip and Leg Pain	5099-5003	10%	Right Femoral Neck Stress Fracture	5255	10%	20040913	
			Left Femoral Diaphyseal Stress Fracture	5252	0%	20040913	
			Left Femoral Neck Stress Fracture	5255	0%	20040913	
			Right Leg Condition 	5208	NSC	20040913	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Bilateral Hip and Leg Pain.  The PEB combined the right and left hip and leg conditions under a single disability rating, coded analogously to 5003 and rated 10% IAW the US Army Physical Disability Agency pain policy.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the left and right hip and leg conditions is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral hip and leg condition began in September 2003 after basic training with no specific injury.  She was noted to have bilateral femoral neck and left femoral diaphyseal high grade stress fractures which required non-weight bearing for over four months.  She was unable to complete the fitness test or other physical requirements for graduation.  During the 8 December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported no specific complaints.  Physical examination revealed a tender right hip and positive tenderness of the sacroiliac joint with the Patrick test.  Hips had full range of motion (ROM).  

The 12 January 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent pain in her left hip and leg and constant pain in her right hip.  Physical examination showed the CI required crutches to ambulate, but the left hip and femoral diaphysis were without tenderness and both the left knee and hip showed full ROM with a negative Patrick test.  The right hip displayed tenderness and a positive Patrick test with full ROM.  There was no mention of painful motion.  At the 23 January 2004 orthopedic examination, 7 days prior to separation, the CI reported having no pain for several months.  Physical examination showed full active ROM of the bilateral lower extremities and the CI was able to perform a full squat.  

At the 13 September 2004 VA Compensation and Pension (C&P) bone examination, 5 months after separation, the CI reported constant 1/10 right greater than left hip pain.  Physical examination showed tenderness from the inguinal area to the greater trochanters bilaterally.  Her active ROM of the right hip was extension of 10 degrees (normal 20), flexion of 95 degrees (normal125), abduction of 50 degrees (normal 45), adduction of 25 degrees (normal), external rotation of 60 degrees (normal 45) and internal rotation of 40 degrees (normal).  ROM of the left hip was extension of 10 degrees, flexion of 110 degrees, abduction of 50 degrees, adduction of 25 degrees, external rotation of 60 degrees and internal rotation of 40 degrees.  She experienced greater trochanteric to deep gluteal area discomfort at all extremes of motion.  

Right Hip Pain.  The panel first considered if the right hip condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Panel members agreed that the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform her military duties and accordingly a separate disability rating is recommended.  

The panel directed attention to its rating recommendation based on the above evidence.  The VA rated the right hip condition 10%, coded 5255 (femur, impairment), based on the C&P examination, citing decreased ROM and pain.  There was no limitation of flexion, extension, abduction, adduction or rotation that supported a rating under the VASRD diagnostic codes for limitation of motion (5251, 5252 or 5253).  Likewise, there was no hip flail joint that supported a rating under VASRD code 5254.  However, there was evidence of slight hip disability to justify a 10% rating under 5255 (femur impairment).  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 right hip condition coded 5255.

Left Hip Pain.  The panel considered if the left hip condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Panel members agreed that the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform her military duties and accordingly a separate disability rating is recommended.  

The panel directed attention to its rating recommendation based on the above evidence.  The VA rated the right hip condition 0%, coded 5255, based on the C&P examination.  There was no limitation of flexion, extension, abduction, adduction or rotation that supported a rating under the VASRD diagnostic codes for limitation of motion (5251, 5252 or 5253).  Likewise, there was no hip flail joint that supported a rating under VASRD code 5254.  However, there was evidence of slight hip disability to justify a 10% rating under code 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 5255.

Left Leg Pain.  The panel considered if the left leg condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Panel members agreed that the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform her military duties and accordingly a separate disability rating is recommended.  

The panel directed attention to its rating recommendation based on the above evidence.  The VA rated the left leg condition 0%, coded 5252 (limitation of thigh flexion), based on the C&P examination.  There was no limitation of flexion, extension, abduction, adduction or rotation that supported a rating under the VASRD diagnostic codes for limitation of motion (5251, 5252 or 5253).  Likewise, there was no hip flail joint that supported a rating under VASRD code 5254.  There was no impairment of the left or right femur with fracture of shaft or anatomical neck with nonunion; or fracture of the surgical neck with a false joint; or malunion with slight knee or hip disability to justify a rating under 5255.  There was no evidence of painful motion of the left knee with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 0% for the left leg condition, analogously coded 5299-5255.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel majority recommends a disability rating of 10%, coded 5255 IAW VASRD §4.71a.  In the matter of the left hip condition, the panel majority recommends a disability rating of 10%, coded 5255 IAW VASRD §4.71a.  In the matter of the left leg condition, the panel majority recommends a disability rating of 0%, analogously coded 5299-5255 IAW VASRD §4.71a.  The single voter for dissent recommends no modification but does 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	
Chronic Right Hip Pain	5255	10%	
Chronic Left Hip Pain	5255	10%	
Chronic Left Leg Pain	5299-5255	0%	
COMBINED	20%	

The following documentary evidence was considered:

[AR NUMBER], XXXXXXXXXX

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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. 

				      
Enclosure