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:  PD1201638
BRANCH OF SERVICE:  Army	BOARD DATE:  20130514
SEPARATION DATE:  20030503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (97E/Interrogator) medically separated for chronic right hip pain.  CI was struck by a car in Oman on 21 February 2002.  He had fractures in the right femur, pelvis, and facial bones; and was evacuated to Landstuhl, Germany where he had a nailing of the femoral fracture.  The CI was placed on 6 months of convalescent leave.  He participated in physical therapy but was unable to be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board.  The chronic right hip pain condition was found medically unacceptable, and was forwarded to the Physical Evaluation Board IAW AR 40-501.  The MEB also identified and forwarded five other conditions, recurrent Fuchs heterochromic iritis, vision defect, right testicular atrophy, residual numbness and pain anterior maxilla, and high frequency hearing loss, left ear for PEB adjudication. The Informal PEB adjudicated chronic right hip pain as unfitting, rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated with a 10% disability rating.

CI’s CONTENTION:  The CI elaborated no specific contention in his application.

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 chronic right hip pain condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in his application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20030121 | VA - (1 mo. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Right Hip Pain | 5099-5010 | 10% | Residuals Status Post Fracture of Femur and Acetabulum Right Hip with Operative Reduction and Internal Fixation | 5299-5255 | 20% | 20030416
No Additional MEB/PEB Entries | Other x 6 |
Combined:  10% | Combined:  20%
Derived from VA Rating Decision (VARD) dated 20030509 (most proximate to date of separation [DOS]) 

ANALYSIS SUMMARY:

Right Hip Pain.  In February 2002, the CI was struck by a motor vehicle in Oman.  He suffered facial fractures, right femur fracture, and right hip acetabular fracture.  He was aeromedically evacuated and subsequently underwent open reduction/internal fixation of his fractures.  Postoperatively, he recovered substantially and resumed ambulation.  However, his right hip pain persisted, and an MEB was initiated.  At his orthopedic evaluation performed in August 2002, the CI reported constant pain in his right hip.  Increased activity increased the pain.  He required the use of a cane, and had an antalgic gait.  Neurovascular examination of the extremities was normal.  Radiographs of the pelvis showed a well-healed acetabular fracture with maintenance of the joint space.  The MEB physical examination performed in December 2002.  The CI required a cane for ambulation greater than 1/8 of a mile.  He was unable to tolerate impact activities, or sitting in one position for more than 5 minutes.  Exam showed no tenderness to pressure about the hips except over the right sciatic area.  Range-of-motion (ROM) of the right hip was measured, and is summarized in the chart below.  He was able to cross his legs without difficulty.  A detailed neurological examination was unremarkable.

At the VA Compensation and Pension exam performed 2 weeks prior to separation, the CI reported that he was unable to do any lifting or carrying, and was unable to perform yard work.  He walked with a moderately antalgic gait using a cane.  Muscle strength and deep tendon reflexes (DTRs) were normal.  The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Hip ROM

MEB – 5 mos. Pre-Sep
(20021219)

VA C&P – 2½ weeks Pre-Sep
(20030416)

Flexion (125⁰ is normal) | 120⁰ | 115⁰
Abduction (45⁰ is normal) | 35⁰ | 25⁰

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  The Army PEB and the VA chose different coding and rating options for the right hip condition.  After a thorough review of the service treatment record, the Board determined that IAW the Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.71a, an appropriate diagnostic code for the right hip condition was 5299-5255 (impairment analogous to malunion of the femur).  The Board also determined that the CI’s hip disability was best described as “moderate.”  There was not sufficient evidence in the treatment record to support classifying the hip disability as “marked.”  The Board tried to find a path to a higher rating using other codes which could be applied to the right hip disability.  The other VASRD codes that were considered did not result in a higher rating, since the STR did not show sufficient evidence of a significantly disabling hip abnormality which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board recommends by majority decision (2:1 vote) a rating of 20% for the chronic right hip condition.  It is appropriately coded 5299-5255, and IAW VASRD §4.71a, meets criteria for the 20% rating level due to moderate hip disability.

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 may have been operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right hip condition, the Board majority (2:1 vote) recommends a disability rating of 20%, coded 5299-5255, IAW VASRD §4.71a.  The single voter for dissent (who recommended no change in the PEB adjudication) did not elect to submit a minority opinion.  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
Chronic right hip pain, with loss of motion | 5299-5255 | 20%
COMBINED | 20%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120823, 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 AR20130012148 (PD201201638)

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 20% 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

PD1201638