RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-06072
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090527

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Wheeled Vehicle Mechanic, medically separated for “chronic left hip pain” and “degenerative arthritis of the lumbar spine,” rated 10% each with a combined disability rating of 20%.

CI CONTENTION: “Review all conditions.” The CI also requested review of additional 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 20090204	VARD - 20090626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain	5099-5003	10%	Left Hip Strain	5252	10%	20090323	
Degenerative Arthritis of the Lumbar Spine	5242	10%	Degenerative Disc Disease, Lumbar Spine	5242	10%	20090323	
Meralgia Paresthetica	Not Unfitting	
No VA Placement	
Hematuria/Proteinuria	Not Unfitting		
Latent Tuberculosis	Not Unfitting		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Left Hip Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left hip condition began in 2001 due to prolonged running. An X- ray in April 2006 and an MRI in May 2008 were normal. The 17 November 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of left hip pain worsened with

activity. Physical examination showed a normal gait, but there was left hip tenderness. Range  of motion (ROM) testing showed flexion of 112 degrees (normal 125), extension of 21 degrees (normal 30) and abduction of 44 degrees (normal 45) with painful motion.

At the 23 March 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported left hip pain. The examiner found normal posture and gait. Hip ROM was bilaterally symmetric with flexion of 125 degrees, extension of 20 degrees and abduction of 45 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion of a major joint. The VA also rated the left hip condition 10%, coded 5252 (thigh, limitation of flexion), based on the C&P examination, citing painful or limited motion of a major joint. All examinations in evidence documented sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or thigh impairment for greater than a 10% rating (codes 5251, 5252 or 5253). The panel next considered ratings analogous to code 5255 (femur, impairment of) and adjudged that the CI’s impairment at separation did not more nearly approximate the “moderate” knee or hip disability level to warrant the next higher (20%) rating. 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 left hip condition.

Degenerative Arthritis of the Lumbar Spine. According to the STR and MEB NARSUM, the back condition began while the CI was undergoing evaluation of the left hip. An MRI in August 2008 revealed minimal degenerative disk disease with a disc bulge at L4-5. The MEB NARSUM examination noted complaints of chronic back stiffness and episodic back pain flare-ups. Physical examination showed a normal gait without tenderness, but there was evidence of muscle spasm. ROM testing showed flexion of 90 degrees (normal) and combined ROM of 225 degrees (normal
240) with painful motion.

At the 23 March 2009 VA C&P examination, 2 months before separation, the CI reported back pain. Physical examination showed a normal gait and posture. There was back tenderness without spasm. ROM testing showed flexion of 90 degrees and combined ROM of 240 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing limitation of combined ROM and muscle spasms. The VA also rated the back condition 10% coded 5242, based on the C&P examination, citing painful motion. The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination, or painful motion as reported on all examinations proximate to separation. There was no 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. There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula. 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 back condition.

Contended PEB Conditions: Meralgia Paresthetica, Hematuria/Proteinuria and Tuberculosis. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards. There was no performance-based

evidence from the record that showed how any of the conditions 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 determinations for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended meralgia paresthetica, hematuria/proteinuria and latent tuberculosis, 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-2017-06072

AR20190009723, XXXXXXXXXXXXXXXXX 

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.

		PD-2017-06072