RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xxxxxxxxxxxxxxxxxxx	CASE:  PD-2020-00149
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Electrician, medically separated for “bursitis, trochanteric, right hip” and “right inguinal pain” rated 10% and 0%, respectively, with a combined disability rating of 10%.    

CI CONTENTION:  “I would like the board to look at all 5 of the diagnoses on my medical board to include left groin pain, lumbar degenerative disk disease, cervical spine pain, right hip chronic bursitis with bone spur and chronic ilioinguinal nerve pain secondary to herniorrhaphy with mesh replacement.”  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 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 - 20081208	VARD - 20090805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bursitis, Trochanteric, Right Hip	5019	10%	Bursitis, Right Hip	5019-5252	10%	20090428	
Right Inguinal Pain	8799-8730	0%	Right Inguinal Hernia, Status Post Hernia Repair	7338	0%	20090430	
Cervical Spine Pain	Medically Acceptable	Cervicalgia	5237	NSC	20090428	
Lumbar Degenerative Disc Disease	Medically Acceptable	Lumbosacral Spine Disc Disease	5243	10%	20090428	
Left Groin Pain	Medically Acceptable	Left Groin Strain	5319	10%	20090430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Hip Trochanteric Bursitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a right hip injury in June 2006 during Airborne training.  An MRI study on 14 April 2008 revealed the possibility of a moderate size bone spur along the greater trochanter area; a bone scan was normal.  Conservative treatment did not improve the symptoms.

During the 1 October 2008 MEB physical therapy range of motion (ROM) study, the CI reported hip pain affecting his ability to stand, sit, or bear weight.  Measured ROM showed flexion to 76 degrees (normal 125) and abduction to 25 degrees (normal 45), with painful motion.   Limitation of external rotation prevented the CI from being able to toe out more than 15 degrees and limitation of adduction prevented her from crossing her legs.

The 3 November 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant pain worsened by lifting, bending, sitting longer than 10 minutes, or standing more than 20 minutes.   Physical examination revealed a normal gait and right hip tenderness.  

At the 28 April 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported daily right hip pain rated at 4/10, and the examiner noted mild greater trochanter tenderness.  Bilateral lower extremity muscle strength as well as bulk and tone were normal, with sensation intact. Right hip flexion was to 120 degrees and abduction to 50 degrees, without pain.  There was slight discomfort during flexion and abduction.  

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 limitation of motion of one major joint.  The VA also rated the right hip condition 10%, analogously coded 5019-5252 (bursitis-thigh, limitation of flexion) based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  Panel members agreed that a 10% rating, but no higher, was justified for the right hip condition, since there was no compensable limitation of thigh flexion or extension (5251 and 5252).  While a 10% rating under code 5253 (thigh, impairment of) was warranted based on limitation of adduction and rotation with the inability to cross legs and toe out more than 15 degrees, a change in coding provided no rating benefit to the CI.  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. 

Right Inguinal Pain Following Herniorrhaphy.  According to the STR and MEB NARSUM, the CI underwent a right inguinal herniorrhaphy with mesh on 6 February 2007 after pulling his groin during lifting.  The pain continued despite surgery and did not improve with treatment.
 
The MEB NARSUM examination noted CI complaints of constant right groin pain with exacerbations during movement.  Physical findings showed a normal gait, but right inguinal area tenderness and swelling.  There was no evidence of herniation or impaired motor or sensory function.

At the VA C&P examination, the CI reported recurrent right groin pain since his surgery.  The examiner found no evidence of recurrent hernia and no need for any type of support.  Sensation, peripheral motor nerve function, strength were normal strength in all four extremities.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right inguinal condition 0%, analogously coded 8799-8730 (neuralgia, ilioinguinal nerve), citing moderate incomplete paralysis.  The VA also rated the right inguinal condition 0%, coded 7338 (hernia, inguinal), based on the C&P examination.  Panel members agreed that a 0% rating (mild-moderate), but no higher, was justified for the inguinal condition, since there was no evidence of severe neuralgia or neuropathy symptoms.  There were no additional codes to consider for this condition.  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 inguinal condition.  
Contended PEB Conditions:  Cervical Spine Pain, Lumbar Degenerative Disc Disease, and Left Groin Pain.  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 or specifically implicated in the commander’s statement, nor did they fail retention standards.  Therefore, panel members agreed there was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance.  After due deliberation, the panel concluded there was insufficient cause to recommend a change for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right inguinal condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cervical spine, lumbar spine and left groin conditions, the panel recommends no change.  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.   

The following documentary evidence was considered:

AR20210005024

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.