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:  PD1201031
BRANCH OF SERVICE:  Army 	BOARD DATE:  20130313
SEPARATION DATE:  20021209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistical Specialist) medically separated for chronic pain in the right hip.  Mild, intermittent discomfort was first reported in 1999 but became progressively more constant and severe during the following year.  The CI was treated with various medications and therapeutic exercise but could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty (MOS) or physical fitness standards.  She was consequently issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “right snapping hip syndrome (iliocillus syndrome)” as not meeting retention standards IAW AR 40-501.  No other conditions were forwarded by the MEB.  The Physical Evaluation Board (PEB) adjudicated “Chronic pain, due to snapping hip syndrome” as unfitting, rated 10% and cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated with a 10% disability rating.

CI CONTENTION:  “The condition has gotten a lot worse over the past 13 years, and has started causing trouble and pain with my left hip.”   

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 condition of chronic pain due to snapping hip syndrome 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 Army Board for Correction of Military Records.  The Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is therefore confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veteran’s Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:  

Service PEB – Dated 20020823 | VA -  (7 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic pain, due to snapping hip syndrome, rated as slight/constant | 5099-5003 | 10% | Right snapping hip syndrome | 5299-5255 | 10% | 20030224
No Additional MEB/PEB Entries | Other x 4 | 20030227
Combined:  10% | Combined:  10%
VARD 20030319 (most proximate to Date of Separation)

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which her service-incurred condition continues to burden her.  It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  This role and authority is granted by Congress to the Department of Veterans' Affairs (DVA).

Right Snapping Hip Syndrome.  The CI reportedly developed right hip pain, with snapping without history of trauma, in 2000.  Radiographs (2000), bone scan (2000), scanogram (2002) and magnetic resonance imaging (MRI 2002) of the hips were all negative for hip pathology.  The hip pain was treated conservatively with unsustained improvement.  Clinic examination approximately a year prior to separation revealed full range-of-motion (ROM) of the hip, hip click on extension, without tenderness, or signs of inflammation, a positive faber’s test and a normal neuromuscular exam.  Orthopedics examination, approximately a year prior to separation, noted hip pop with extension, full ROM, and normal sensory/motor exams, and diagnosed Iliopsoas syndrome of the right hip.  Surgery was discussed, but not performed (CI wanted it).  Last documented evaluation 9 months prior to separation, recorded report of daily “popping” during activity, X-ray results showing mild scoliosis of thoracolumbar spine and the report of negative studies for autoimmune diseases.  The CI received a permanent profile that stated she could walk at her own pace, march up to five miles and bicycle and swim without any limitations.  At the MEB narrative summary (NARSUM) evaluation on 19 July 2002, approximately 5 months prior to separation, the CI reported pain and popping of the hip with initially mild and intermittent but progressively became severe over the first year.  The pain at times radiated to the right lower back and upper leg.  On physical examination, ROM was recorded as full, there was no tenderness to palpation, no effusions, deep tendon reflexes 2/4, normal motor exam, and a palpable, audible pop with hip extension.  At the Compensation and Pension (C&P) examination on 24 February 2003, approximately 2 months after discharge, the CI reported low back pain (LBP) with three episodes of radiating out of the back into the right leg around the knee.  She had one episode of tingling in the right leg around the knee.  Physical examination revealed hip flexion of 120 degrees, abduction of 50, internal and external rotations of 30 and 55 degrees, respectively.  She had popping with associated pain with extension of her hip after maximum flexion.  The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the condition at 10% using different codes.  The PEB rated IAW the USAPDA pain policy and coded the condition analgous 5099-5003 (degenerative arthritis).  The VA rated the condition under 5255 (impairment, femur).  The Board adjudged that the record did sufficiently document pain on motion to meet the requirement of §4.59.  A higher under the 5003 code requires occasional incapacitating exacerbations for which were not reflected in the record at hand.  A higher rating under the 5255 code requires significant hip disability which was not supported by the profile and service treatment records.  The Board unanimously agreed the condition was not compensable under range of motion codes.  Given the record of evidence the Board could not find other applicable VARSD codes for consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic hip pain was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board.  In the matter of the chronic right hip pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Pain Due To Snapping Hip Syndrome | 5099-5003 | 10%
COMBINED | 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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130007446 (PD201201031)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD1201031