RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX CASE: PD1201488 BRANCH OF SERVICE: ARMY BOARD DATE: 20130327 SEPARATION DATE: 20031212 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated active duty SPC/E-4 (71L/Administrative Specialist) medically separated for left hip pain. He sustained a hip dislocation in 2002 while running. The condition could not be adequately rehabilitated after surgery to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left hip condition, characterized as “left hip dislocation with posterior wall acetabula fracture status post (s/p) open reduction and internal fixation (ORIF),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated the left hip condition as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI did not concur with the IPEB findings and after review by the USAPDA the IPEB findings were affirmed. The CI was medically separated with a 0% disability rating. CI CONTENTION: “After separating from the Army, I am heavily disabled and barely able to go about daily activities.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The rated, unfitting left hip pain condition meets the criteria prescribed in DoDI 6040.44 for Board purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20030821 VA - (12 Mos Post-Separation) Condition Code Rating Condition Code Rating Exam Left Hip Pain 5099-5003 0% Residuals, Left Hip Dislocation with Posterior Wall Acetabular Fracture Status Post ORIF 5252 20% 20040225 No Additional MEB/PEB Entries Other x 4 20041207 Combined: 0% 30% Derived from VA Rating Decision (VARD) dated 20041025 (most proximate to date of separation [DOS). ANALYSIS SUMMARY: Left Hip Condition. The narrative summary (NARSUM - coupled with the MEB DD Form 2807) notes a left hip injury with running with a posterior wall acetabular fracture and subsequent ORIF on 18 September 2002 (15 months prior to separation). At the MEB exam, the CI reported always being in pain from his hip and being severely limited in what he could do. The MEB physical exam noted a non-antalgic gait and left hip range-of-motion (ROM) of 0-95 degrees (normal 125 degrees), normal motor strength and no sensory or vascular deficit. Current function was noted as “on profile restricting him from running, unable to do sit-ups or marching. He was unable to do side-straddle hops, jumping or lift any heavy weight.” Recommendation noted PEB referral “secondary to the seriousness of his injury and the potential complications of avascular necrosis of the femoral head and in addition to subsequent post fracture arthritis which could all be accelerated by continued active service demands of his MOS and duty in the United States Army.” At the VA Compensation and Pension (C&P) exam performed 12 months after separation, the CI reported immediate left hip pain with walking. Exam documented left quadriceps (thigh muscle) circumference of 62 cm (compared to 66 cm on the opposite side), a limp on his left hip, and painful flexion to 70 degrees (normal 125 degrees). The examiner stated “I would expect chronic pain, loss of motion, lack of endurance in the left hip. Range of motion loss would be 40 degrees or more with flareups or repetitive use. I would expect a chronic gait disturbance (DeLuca ROM of 30°).” The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the CI at 0% coded 5099-5003 and rated for pain. The VA rated the CI at 20% coded 5252 based on exam 12 months after separation and with consideration of DeLuca criteria. The ROM was to 95 degrees while the VA exam ROM was to 30 degrees. It is obvious that there is a clear disparity between these examinations, with very significant implications regarding the Board's rating recommendation. The Board considered the tenants of VASRD §4.7 (Higher of two evaluations) and thus deliberated the probative value assignment to these conflicting evaluations, and carefully reviewed the file for corroborating evidence. The VA ROM was more remote from separation and the service record did not demonstrate episodes of similarly limited ROM. The Board adjudged that the MEB exam had the highest probative value for rating at the time of separation and that there was sufficient evidence of pain-limited motion to concede painful motion IAW VASRD §4.59. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 10% for the left hip condition. 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 was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left hip condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board 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 Left Hip Pain s/p Dislocation, Acetabular fracture and ORIF 5099-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120808, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxxxxxx, AR20130008739 (PD201201488) 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 xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)