Author: JOHN J. D'ORAZIO
Last saved by: BARKSDALE, JAMEILL M GS7 USAF SAF SAF/MRBE
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1200732
BRANCH OF SERVICE:  Army	BOARD DATE:  20130418
SEPARATION DATE:  20030623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A10/Logistics Supply Specialist) medically separated for chronic bilateral hip pain.  During a command run, she developed severe right lateral thigh pain that was later diagnosed as right greater trochanteric bursitis with right iliotibial band syndrome (ITBS).  The hip condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent P3/U3 profile and referred for a Medical Evaluation Board (MEB).  The hip condition, characterized as chronic bilateral hip pain–greater trochanteric bursitis, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the bilateral hip pain as unfitting, rated 0%.  The CI made no appeals, and was medically separated with at 0% disability rating.

CI CONTENTION:  “Right before I got out I was diagnosed with asthma and because of the timing I was informed that I could not add this to my conditions and that I’d have to go through VA.  I also had a issues with my wrist which I just found out was degenerative arthritis.  During active duty I had several issues with female problems in the summer of 2006 I was diagnosed with Polysystic Ovary Syndrome which causes fertility issues as well as insulin Resistance.  I currently take metformin for this.  me and hubby are currently trying to concieve I believe if this was caught earlier I would not be having the problems I am now.” 

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.  The rating for the unfitting bilateral hip condition is addressed below.  The requested asthma, degenerative arthritis of the wrist, and polycystic ovary syndrome (PCOS) conditions were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board.  The Board acknowledges the CI’s information regarding the significant impairment with which her conditions continue to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans’ Affairs, operating under a different set of laws.  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 Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20030502 | VA - (2 Weeks Pre -Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Bilateral Hip Pain, due to Trochanteric Bursitis w/o Limitation of Motion | 5019 | 0% | Trochanteric Bursitis, Left Hip | 5019 | 10% | 20030604
No Additional MEB/PEB Entries | Trochanteric Bursitis, Right Hip | 5019 | 10% | 20030604
| Other x 4 | 20030604
Combined:  0% | Combined:  60%
Derived from VA Rating Decision (VARD) dated 20030708 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  The PEB combined the bilateral hip conditions as a single unfitting condition, coded 5019 (bursitis) and rated 0%.  The PEB may have relied on AR 635.40 (B.24f) or invoked the United States Army Physical Disability Agency (USAPDA) pain policy for not applying separately compensable VA Schedule for Rating Disabilities (VASRD) codes.  In either case, the Board must apply separate codes and ratings in its recommendation, since compensable ratings for each condition is achieved IAW VASRD §4.71a.  The Board does maintain the prerogative of separate fitness recommendations in cases where two or more joints are combined by the PEB as a single unfitting condition, with the caveat that such recommendations may not produce a lower combined rating than the single PEB rating.

Bilateral Hip Condition.  The narrative summary (NARSUM), 4 February 2003, approximately 5 months prior to separation, notes that the CI developed right hip pain following a run in 2002.  She was diagnosed with right hip bursitis.  X-rays of the right hip, 14 May 2002, and bone scan, 11 June 2002, of the hips and lower extremities were normal.  Lumbar spine films, 13 November 2001, were normal except for an increased lordotic curve.  Despite treatment, the CI’s right hip pain persisted and she developed left hip pain.  At the MEB exam, 4 February 2003, approximately 5 months prior to separation, the CI reported bilateral hip pain, right greater than left.  She reported pain located over the right greater trochanter and described it as a constant, throbbing pain that radiated down the side of the leg to her knee.  The pain was worse with walking more than 10 minutes; squatting; lifting heavy objects; or sleeping on her right side.  The CI noted a mild ache over the left hip, not nearly as severe as on the right which she attributed to her altered gait due to the right hip pain.  She reported no weakness, numbness, tingling or radiation of the pain on the left side.  The MEB physical exam noted right hip range-of-motion (ROM) of flexion, extension, and abduction was normal and painful motion was noted.  There was tenderness to palpation (TTP) of the greater trochanter.  Right hip muscle strength was normal.  The left hip ROM of flexion, extension, and abduction was normal.  There was pain with all motions, without TTP of the left greater trochanter; strength was normal.  Specific tests for hip flexion contracture, muscle weakness, and tendon tightness were negative bilaterally.  Evaluation of the lumbar spine showed normal ROM without evidence of joint disease, nerve compression, or sacroiliac dysfunction.  Deep tendon reflexes (DTR) and sensation of both lower extremities were normal.  At the VA Compensation and Pension (C&P) exam, 4 June 2003, approximately 3 weeks prior to separation, the CI reported pain weakness, stiffness and fatigue and lack of endurance of both hips.  On exam, posture and gait were normal and there was no deformity of either hip noted.  There was TTP of both the right and left greater trochanters.  Bilateral hip ROM was normal.  Painful motion occurred on the right with all motions; on the left with limited motions.  Pain, weakness, and fatigue increased throughout ROM of both joints with repetition.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB bundled the bilateral hip pain rated as one unfitting condition as 5019 (bursitis) at 0%.  The VA rated each hip separately as 5019 at 10% for painful motion.  The Board first undertook to unbundle the right and left chronic hip pain conditions.  The treatment notes in the service treatment record for hip pain indicate treatment for right hip pain.  No notes in the record indicate treatment of the left hip.  The commander’s statement referred only to the CI’s “disability,” without specifying right or left hip.  The permanent profile noted bilateral hip pain; the preceding temporary profiles were for the right hip pain condition.  The treatment records indicate that the CI was profiled and was unable to perform the duties of her MOS due to her right hip pain.  The Board opined that the evidence in the record supports that at the time of separation the right hip pain was an unfitting condition.  The first reference to left hip pain is in the NARSUM and the CI noted that she felt the left hip pain was due to the way she had been walking from the pain on the right.  At the MEB exam, the CI reported the left pain “is not nearly as severe as the right side, but it has been a constant pain“, and a “constant mild ache over the left greater trochanter.”  At the time of separation, the left hip pain was mild and had not been assessed as needing treatment by the CI or her medical providers.  There was no performance based evidence in the record that the CI’s mild left hip pain impaired duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to support that the left hip pain was a separately unfitting condition at the time of separation.  Therefore, could not be recommended for separate disability rating.  The Board considered rating the chronic right hip pain condition as limited ROM or as bursitis.  At both the MEB and C&P exams, the CI had normal but painful ROM of the right hip.  The Board agreed that there was no compensable loss of ROM of the right hip and whether coding as ROM or 5019, the highest achievable rating is 10% for painful motion.  The Board chose 5019 (bursitis) as most consistent with the CI’s condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right hip pain 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, the PEB may have relied on AR 635.40 (B.24f) or invoked the USAPDA pain policy PEB for rating the chronic bilateral hip pain condition and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic bilateral hip pain condition, the Board unanimously recommends a disability rating as follows: an unfitting right hip pain condition rated at 10% IAW VASRD §4.71a. coded 5019 and a not unfitting left hip pain condition.  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 her prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Right Hip Pain | 5019 | 10%
COMBINED (w/ BLF) | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130010298 (PD201200732)

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						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD1200732