RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04871
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “chronic limiting right hip pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to the right hip, right shoulder and recurring bone tumors, the CI requested review of other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080326	VARD - 20081020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Limiting Right Hip Pain 	5019	10%	Degenerative Arthritis, Right Hip	5019-5252	10%	20080731	
Right Femur Benign Neoplasm	Not Unfitting	No VA Placement	
Right Shoulder Pain	Not Unfitting	Right Shoulder Tendonitis	5203	NSC	20080731	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in June 2001 with gradual onset due to weight bearing activities.  He was diagnosed with a tumor on the right femur and underwent multiple surgical procedures in 2004 and 2005 for tumor removal, biopsy, hardware removal and infection, with recurrent tumor removal in April 2006.  The tumor was found to be benign (enchondroma).  In April 2007, following the last surgery, the CI was diagnosed with “intractable trochanteric bursitis” and had the surgical hardware removed. An orthopedic specialist noted that imaging studies showed no sign of tumor recurrence.  The 6 September 2007 orthopedic examination, 7 months prior to separation, showed an antalgic gait, but normal alignment of the right hip.  Hip range of motion (ROM) in degrees was flexion of 90 (normal 125), internal rotation of 10 (normal 40), external rotation of 30 (normal 60) and abduction of 40 (normal 45).  There was no crepitus or tenderness with ROM testing, but there was tenderness with straight leg raise (in this case signifying hip related pain).  He was diagnosed with trochanteric bursitis and given a permanent profile for no running due to chronic trochanteric pain and to prevent fracture.  At the 24 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the examiner noted tenderness of the trochanteric region without swelling, warmth or redness.  During the 12 October 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported right hip pain that radiated to the buttock and groin area, aggravated by weight bearing and repetitive hip motions.  He reported that at the time of pain he could function with medication.  The physical therapy ROM study on 13 November 2007 showed, in degrees, flexion of 110, extension of 25 and abduction of 30 with painful motion.  

At the 31 July 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant right hip pain, weakness, stiffness, lack of endurance and fatigability. Physical examination showed an antalgic gait favoring the right leg.  There was no leg length discrepancy, swelling, weakness, redness, heat, subluxation or guarding of movement.  Hip ROM in degrees was flexion of 125, extension of 30, adduction of 25, abduction of 45 and external rotation of 60 degrees with pain at end ROM of flexion and abduction.  Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  Right hip X-rays showed degenerative arthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded 5019 (bursitis), citing mechanical loss of joint motion.  The VA also rated the right hip condition 10%, dual coded 5019-5252 (bursitis causing limitation of thigh motion), based on the C&P examination, citing painful limitation of motion.  Although there was evidence of painful hip motion with functional loss supporting a 10% rating based on §4.59 and §4.40, the panel considered rating the CI’s hip disability analogously to femur impairment (5299-5255).  Imaging studies of the femur after the last surgery showed the tumor resection cavity filled with methymethacrylate and the orthopedic surgeon counseled the CI that following removal of surgical hardware in April 2207, he would be at “marked risk for fracture.”  The panel judged that this analogized well to malunion of the femur in the case of a fracture and the panel recommends a 20% rating for moderate hip disability, supported by limited and/or painful hip ROM and antalgic gait documented by the orthopedic and C&P examinations.  There was no evidence of marked hip or knee disability, a “false joint” at the site of the fracture or nonunion of the femur fracture to support a higher rating than 20%.  There was no limitation of thigh motion (5251, 5252, 5253) to support a higher rating and no history of a flail (5254) or ankylosed hip joint (5250) for rating consideration under the respective codes.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right hip condition, coded 5299-5255.  

Contended PEB Conditions.  Right Femur Benign Neoplasm and Right Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The femur neoplasm was discussed above with the chronic right hip pain and both conditions reflect the same disability and are not separately ratable IAW VASRD §4.14 (avoidance of pyramiding).  According to the orthopedic specialist, imaging showed no recurrence of the tumor proximate to separation.  The CI’s right trochanteric bursitis and right hip arthritis resulted from his multiple surgeries for the benign proximal femur neoplasms and any residual disability due to the benign neoplasms is subsumed under the panel’s §4.71a chronic hip pain rating above.  The right shoulder condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition, the panel recommends a disability rating of 20%, coded 5299-5255 IAW VASRD §4.71a.  In the matter of the contended right femur benign neoplasm and right shoulder 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.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Limiting Right Hip Pain 	5299-5255	20%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure