RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201544 SEPARATION DATE: 20040826 BOARD DATE: 20130227 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (Basic Trainee) medically separated for left hip pain, due to left femoral neck fracture. He was treated, but was unable to continue Basic Training. The CI was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB). The MEB found his left hip pain medically unacceptable, and referred him to a Physical Evaluation Board (PEB). No other conditions were listed on DA Form 3947. The PEB found his left hip condition unfitting, and rated it 0% IAW the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with 0% disability. CI CONTENTION: In March 2004, I suffered a fracture to the left femoral neck. As a result, I was determined physically unfit for duty and medically discharged. Since that time, approximately 8½ years later, I continue to experience periods of mild to moderate discomfort in my left hip. This can sometimes be the result of exercise (running, jogging, etc), or dramatic changes in weather (temperature, humidity, etc). In addition, pain has been experienced in my left hip and cannot be traced to any specific cause (weather, exercise, etc). In attempting to explain the level of pain that I sometimes experience, I consider mild pain to be a dull ache to moderate pain being more of a sharp pain/ache that results in a mild limp when walking.” SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44, is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The unfitting hip condition (left hip pain with history of femoral neck fracture) meets the criteria prescribed in DoDI 6040.44 for Board purview, and is accordingly addressed below. No other conditions are within the Board’s purview. Any condition outside the Board’s defined scope of review may be eligible for future consideration by the Army Board for the Correction of Military Records. RATING COMPARISON: Army PEB – dated 20040706 VA – Effective 20040827 Condition Code Rating Condition Code Rating Exam Left Hip Pain 5099-5003 0% Left Femoral Neck Fracture 5299-5250 0% STR* Rating: 0% Rating: 0% *CI failed to report for two VA compensation and pension (C&P) exams ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his left hip condition continues to burden him, and the significant impact that it has had on his quality of life. It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the military Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate the CI for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs (DVA). The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. Compensation can only be granted for the degree of severity present at separation. The DVA, however, is empowered to re-evaluate a CI’s conditions for the purpose of adjusting the disability rating should the degree of impairment change over time. Left Hip Condition. During Basic Training, the CI fractured the femoral neck of his left femur. Due to this injury, he was not able to continue Basic Training and an MEB was initiated. His MEB clinical evaluation was at Fort Jackson on 27 May 2004. At that time, he was in no acute distress, but he walked with a limp. Left hip range-of-motion (ROM) was measured, and is summarized in the chart below. Left Hip ROM MEB – 3 mos. Pre-Sep (20040527) Flexion (125° is normal) 90° Abduction (45° is normal) 50° Comment mild pain with motion §4.71a Rating 10%* *10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) The CI filed a claim with the VA, but failed to appear for his VA Compensation and Pension (C&P) exams on 30 August 2005 and 10 September 2005, so there was no clinical data from those exams. The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. Using information in the treatment record, the CI’s left hip was essentially non-compensable based on the VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253). However; IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. The Board tried to find a path to a higher rating for the left hip, but there was not sufficient evidence to justify a rating greater than 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability separation rating of 10% for the left hip condition. It is appropriately rated 5299-5252 and IAW VASRD §4.40, §4.45, §4.59, and §4.71a; meets criteria for the 10% rating level. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on the USAPDA pain policy for rating the left hip condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left hip pain condition and IAW VASRD §4.40, §4.45, §4.59, and §4.71a; the Board unanimously recommends a disability separation rating of 10%. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic Left Hip Pain, with history of femoral neck fracture 5299-5252 10% RATING 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120813, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxx, AR20130005371 (PD201200586) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)