RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXX	CASE: PD-2017-05393
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090617

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Multichannel Transmission Systems Operator/Maintainer, medically separated from the Temporary Disability Retired List (TDRL) for “chronic and intermittent left hip pain” with a disability rating of 10%.

CI CONTENTION: In addition to a request for a review of all conditions, the CI also requested review of additional conditions not identified by the TDRL separation 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 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 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 - 20090611	VARD - 20090603	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic and Intermittent Left Hip Pain …	5099-
5003	10%	S/P Left Femoral Head Fracture with ORIF Surgery and Scar	5255	20%	20090309	
Lateral (Left) Femoral Cutaneous Nerve Mononeuropathy	Not Unfitting	Left Thigh Neuritis Associated with S/P L. Femoral Head Fracture …	8520	10%	20090309	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Chronic and Intermittent Left Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s hip condition began in June 2006 after sustaining a dislocation and comminuted fracture of the left femoral head while playing football. He underwent open reduction internal fixation in July 2006. The CI was separated and placed on TDRL on 11 April 2007 with a 60% rating for the left hip condition only.

At the 9 March 2009 VA Compensation and Pension (C&P) examination, 3 months before TDRL removal, the CI reported constant pain in the left hip and thigh, with weakness, easy fatigability, loss of strength, , and impairment of coordination. Pain was worse with activity and prevented heavy lifting or bending down. Physical examination showed normal posture and gait. Palpation of the muscle group XIV revealed no loss of deep fascia or muscle substance and no impairment

of muscle tone; strength was normal and there was no muscle wound or other abnormal muscle findings. There were no signs of lowered endurance or impaired coordination. Measured left hip range of motion (ROM) was normal in all planes and symmetric to the opposite side. Pain was present at end ROM. Hip joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. There was a left upper thigh well-healed, hyper-pigmented non-tender scar and decreased sensation in the left upper thigh without motor dysfunction (diagnosed as neuritis of the left external cutaneous nerve of the thigh).

The 18 March 2009 TDRL orthopedic consultation examination noted complaints of left hip pain and occasional popping. X-rays showed surgical screws in place with preserved joint space and minimal degenerative changes. Physical examination showed a left hip well-healed incision with full ROM and normal strength. Sensation was normal in nerves tested below the knee. The CI was able to deep squat with mild discomfort in his hip, and gait was nonantalgic. During the next- day TDRL examination the CI reported left hip pain with infrequent flare-ups. Physical examination revealed a non-antalgic gait. Left hip ROM was flexion of 110 degrees (normal 125) limited by pain; abduction was 45 degrees (normal), and extension was 0 degrees (normal 30) with painful motion. There was tenderness along the lateral aspect of the left hip with a well- healed incision. There was decreased sensation along the left medial and lateral thigh. The CI was able to cross over the lower extremities bilaterally and toe-out to 25 degrees on the left with discomfort. With repeated ROM there was an increase in pain, fatigue, weakness, and lack of endurance but there was no instability or incoordination and no further decrease in ROM. Neurodiagnostic testing reported decreased left lateral thigh sensation with “feeling of his hip coming out of joint” and studies documented left lateral femoral cutaneous nerve mononeuropathy. The examiner indicated two diagnoses: left hip pain status post (S/P) left femoral head fracture and lateral femoral cutaneous nerve mononeuropathy. Both diagnoses met Army retention standards, and prognosis was good for return to military service with profile.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing an unfitting condition due to arthritis with abnormal X-rays and avoidance of exposure to impact and repetitive activities, and rating based on some loss of motion and pain with repetitive activities. The PEB adjudged that the TDRL re-evaluation neuropathy diagnosis was not ratable since it was not listed on the initial MEB and appeared to be a new condition.

The VA rated the hip condition 20%, coded 5255 (femur, impairment), based on the C&P examination, citing malunion of the femur with moderate knee or hip disability. The VA also rated the left thigh neuritis at 10% (mild), coded 8520 (sciatic nerve, paralysis), citing sensory deficit with no motor dysfunction.

Regarding the left hip condition, 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) at the TDRL and VA examinations to support a 10% rating. The panel deliberated if the CI’s disability picture at separation more closely approached the code 5255 criteria for “marked” (30%) or "moderate” (20%) hip disability, and deliberated if the neuropathy condition was separately unfitting and/or part of the left hip single rating. The neuropathy was adjudged as related to, or due to, the unfitting TDRL condition and was therefore in scope. However, the panel agreed that the neuritis was not separately unfitting at TDRL removal, as there was no weakness, and therefore any “feeling of his hip coming out of joint” or flares of pain were best adjudged as part of the single hip joint disability. Considering all symptoms related to the left hip fracture and surgery, the panel determined the CI’s disability picture at separation most nearly approximated a “moderate” (20%) hip disability under code 5255. 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 left hip condition, coded 5299- 5255; and a not unfitting left hip neuropathy.

BOARD FINDINGS: In the matter of the chronic and intermittent left hip pain, the panel recommends a disability rating of 20%, coded 5299-5255 IAW VASRD §4.71a. In the matter of the contended left hip neuropathy, the panel agrees it cannot recommend it for additional disability rating. 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 and Intermittent Left Hip Pain	5299-5255	20%	

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200004107, 

Dear XXXXXXXXXXXXXX:

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,

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