RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05582
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic bilateral hip pain” with a disability rating of 0%.  

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20060214	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Hip Pain	5099-5003	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA%	

ANALYSIS SUMMARY:

Chronic Bilateral Hip Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral hip condition began in 2005 while in basic training and worsened with increased activity.  She reported a “snap and a pop” in her hips when rotating and extending the legs, but bilateral hip X-rays and MRI studies revealed no significant abnormalities.  Despite a variety of treatment modalities, the bilateral hip pain continued.  A clinical encounter on 12 December 2005, 3 months prior to separation, documented bilateral hip tenderness during abduction and extension, but painful motion was not addressed.  Two days later, a physical therapy examination noted painful motion during bilateral hip flexion and internal rotation.  At the 26 January 2006 MEB NARSUM examination, 2 months before separation, the CI complained of bilateral hip pain.  Physical examination revealed a palpable snapping of both hips and “full” bilateral hip abduction and adduction; painful motion was not addressed.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral hip condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing minimal/occasional pain.  Panel members first considered whether each hip condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  Objective clinical and radiologic evidence proximate to the separation remained essentially equivocal to both hips without significant indication of either side being more impaired than the other.  The panel agreed to liberally invoke VASRD §4.3 (reasonable doubt) and concede in favor of the CI that each hip would have rendered her incapable of continued military duties; and, accordingly considered recommended separate ratings for the right and left hip.  While there was no ankylosis, limitation of motion, flail hip joint, or femur impairment to support ratings under those related VASRD diagnostic hip codes, the panel majority agreed the sole physical therapy finding of painful motion during pre-separation examinations warranted application of VASRD §4.59 for a minimum of 10% as applied unilaterally or bilaterally.  The panel majority also concluded that the bilateral diagnosis did support a single 5003 rating based on “2 or more major joints,” as conferred by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral hip condition.  

BOARD FINDINGS:  In the matter of the bilateral hip condition, the panel majority recommends a disability rating of 10%, analogously coded 5003 IAW VASRD §4.71a.  The single voter for dissent recommends a modification to 20% (10% for each hip) based on painful motion and did not elect to submit a minority opinion.  

There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Bilateral Hip Pain	5099-5003	10%	

AR20200004290,

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.