RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-05746
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060607

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5 , Information Systems Operator-Analyst, medically separated for “right hip pain” and “low back pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  Review all conditions.  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 - 20060302	VARD – 20050425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Labral Tear	5099-5003	10%	Right Hip Superior Labral Tear	5252	20%	20050321	
Low Back Pain	5237	10%	Lumbar Spine Degenerative Disc Disease	8520	0%	STR	
Migraine with Aura	Not Unfitting	Tension and Migraine Headaches	8100	NSC	20050321	
Major Depressive Disorder	Not Unfitting	No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Right Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s hip condition began in 1999 WHEN she felt a painful pop in her right hip while doing physical training. The pain persisted, and in 2002 she underwent right hip arthroscopy with partial resection of the labrum.

At the 21 March 2005 VA Compensation and Pension (C&P) examination, 15 months prior to separation, the CI reported chronic right hip pain. The physical examination (PE) revealed a normal gait, but tenderness over the lateral side of the right hip, and significantly limited range of motion (ROM) with flexion to 95 degrees (normal 125), extension to 10 degrees (normal 20) and abduction to 10 degrees (normal 45); painful motion was present. Additionally, evidence of fatigue, weakness, and lack of endurance was noted after repetition.

The 21 December 2005 MEB NARSUM examination, 6 months before separation, noted complaints of right hip pain, and the examiner documented minimal tenderness over the front aspect of the right hip. Measured ROM was 90 degrees of flexion, 40 degrees of abduction and 30 degrees of external rotation (normal 45) with evidence of painful motion. At the 20 June 2006 primary care clinic (PCC) examination, 2 weeks after separation, the CI complained of constant right hip pain, described as burning, aching and sharp in nature which was relieved with rest and narcotic medication. The PE revealed flexion to 100 degrees, extension to 15 degrees, abduction to 28 degrees, adduction to 10 degrees (normal 25) and external rotation to 40 degrees. Although the examiner documented a normal posture and gait, the CI utilized a cane to ambulate.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing moderate and frequent pain. The VA rated the same condition 20%, coded 5252 (limitation of flexion of thigh), based on the C&P examination, citing moderate limited motion of the right hip with painful motion. Panel members agreed that equivalent ratings of 10%, but not higher, for either painful motion (VASRD §4.59) or limitation of adduction to the point of an inability to cross legs (10 degrees of adduction), were warranted. 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 right hip condition.

Low Back Pain. According to the STR and MEB NARSUM, the CI’s back condition began in 2004 as a consequence of altered biomechanics (limping) due to the right hip condition. At the C&P examination, the CI reported lower back pain 1-2 times per week with mild flare-ups that last a few hours. The spine-focused physical examination was completely normal. Motor strength of the lower extremities was normal and there was a slight decrease in pinprick sensation in the right-sided L4-5 nerve root distribution.

At the MEB NARSUM examination, the CI endorsed 1 hour per day of a burning pain in her lower back that worsened with lifting more than 15 pounds, bending, doing sit-ups or with prolonged sitting. The pain improved with rest, heat and pain medication, and she used a cane for ambulation. The PE revealed tenderness about the lower back musculature. Thoracolumbar ROM was painful and showed flexion to 60 degrees (normal 90), extension to 20 degrees (normal 30), and left side-bending to 20 degrees (normal 30). Right side-bending and bilateral rotation were normal, and the combined ROM was 190 degrees (normal 240). At the 20 June 2006 PCC examination, the CI endorsed constant low back pain which was relieved by rest and medication. The examiner documented painful and decreased thoracolumbar ROM with flexion to 80 degrees and bilateral side-bending to 25 degrees each direction. Extension and bilateral rotation were normal, and combined ROM was 220 degrees. There were no indications of intervertebral disc syndrome with chronic or permanent nerve root involvement.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing painful motion. The VA rated the back condition 0%, coded 8520 (paralysis of the sciatic nerve), based on the C&P examination, citing absence of objective painful or limited motion. Panel members agreed that although there was insufficient limitation of motion to support a compensable rating, a 10% rating was justified for the presence of painful motion as described at the PCC examination near

the time of separation. There was no evidence of 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. After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the low back condition.

Contended PEB Conditions: Migraine with Aura and Major Depressive Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Neither of the conditions were profiled or implicated in the commander’s statement, nor failed retention standards. There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at or near separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right hip and low back conditions and IAW VASRD §4.59, the panel recommends no change in the PEB adjudications. In the matter of the contended migraine with aura and major depressive disorder 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. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

PD-2017-05746

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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

PD-2017-05746