RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE:  PD-2013-01853
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20141017
SEPARATION DATE:  20050305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (31B/Military Police), medically separated for a chronic right hip condition.  Her 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 L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB characterized her condition as “chronic iliopsoas tendinitis” as medically unacceptable.  No other conditions were submitted by the MEB.  The Informal Physical Evaluation Board (PEB) adjudicated the right hip condition as “chronic right hip iliopsoas and snapping hip syndrome,” as unfitting and rated it at 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “submitted 3 separate claims; 2 rated 0%, hip fracture (flexor tendon shredded) rated 10% continually seeking treatment for disability. ..what has hindered me in not only my professional life but also personal life.  Still have daily challenges with pain and adaptation.  As well as, can not perform certain tasks.  This can effect my ability to work on my feet, exercise and enjoying other things in life.” 

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 right hip condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 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 Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20050120	VA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Iliopsoas Tendinitis and Snapping Hip Syndrome	5024	0%	Chronic Iliopsoas Tendinitis, Right	5316	30%*	Not Available	
Other x 0 (Not in Scope)	Other x 5	Not Available 	
Combined:  0%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20081121 (most proximate to date of separation [DOS] available).
* Original C&P and VARD are not available. First VARD available dated 20081121 reflect a decrease in rating from 30% to 10%.

ANALYSIS SUMMARY:  In accordance with DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Chronic Right Iliopsoas Tendinitis Condition.  Review of the service treatment records revealed that the CI first noted the gradual onset of a painful, popping, right hip in the autumn of 2003, also associated with symptoms of shinsplints starting in September 2003 and a “borderline stress fracture” of the right tibia.  Examination early in the course of this condition noted (1) pain with running, sit-ups and flutter kicks, (2) an “antalgic gait” and pain with range-of-motion (ROM) of the hip, (3) X-ray report noting “normal right hip,” and (4) bone scan revealing no hip or pelvic fracture.  Physical therapy noted a diagnosis of right hip tendinitis with “developing right tibial stress fracture.”  X-rays of the pelvis and right leg, 13 months prior to separation were read as normal and further imaging of the hip ruled out the presence of a surgically correctable injury.  Without improvement from physical therapy, the CI was referred to orthopedics, which documented right hip pain, especially at the extremes of ROM, with tenderness to palpation of the iliopsoas muscle, non-tender trochanter and bursa, with full ROM of the hip, a negative FABER test (stands for Flexion, ABduction, and External Rotation; is performed to evaluate pathology of the hip joint or the sacroiliac joint) and a diagnosis of “iliopsoas tendinitis.”  The CI was issued a permanent (L3) profile, 7 months prior to separation, prohibited running, marching, squatting and jumping, limited prolonged standing, exercise and recommended for a MEB.  The commander’s memorandum to the PEB listed her limitations and noted that her “physical impairments prevent her from fulfilling the requirements” of her MOS.  At the MEB exam, the CI reported right hip pain, with inability to stand or squat, with limited ability to move her hip.  Pain was “controlled” by rest and medication.  The MEB physical exam noted a normal lower extremity examination, with mild to moderate, symptomatic pes planus (flat feet).

The narrative summary (NARSUM), 5 months prior to separation, noted right hip pain, slight and frequent, worse with a positive FABER test (pain with flexion, abduction and external rotation), with pain when approaching the limits of ROM in all planes.  There was pain with (1) flexion beyond 90 degrees, (2) extension past -5 degrees, (3) external rotation past 20 degrees and (4) nonspecific pain with internal rotation.  Active ROM was not documented, but the passive flexion was documented at 130 degrees and passive extension at -10 degrees.  Strength, sensation and reflexes were normal.  The NARSUM recommended that the diagnosis of chronic iliopsoas tendinitis was medically unacceptable.  The MEB, 3 months prior to separation, also recommended that the condition was medically unacceptable.  The Informal PEB, 2 months prior to separation, found the condition unfitting.  The only VA Compensation and Pension (C&P) examination presented as evidence for this Board to review, dated over 3 years after separation, documented right hip pain, and noted an “examination of the hips within normal limits” with normal ROM, without fatigue, weakness, lack of endurance or coordination and without ROM loss upon repetitive motion.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded this condition under VARD code 5024 (tenosynovitis), rated at 0%, noting pain was mild, and with ROM “essentially full except as prohibited by pain.”  The VARD, dated 3 years after separation, and based upon a VA C&P examination of limited probative value due to the length of time since separation, lowered to 10%, under code 5316, a previous VA rating of 30%, the evidence for which was not presented to this Board for review.  This condition did not meet the criteria for rating under VASRD codes 5251 or 5252 for limited hip ROM.  VASRD code 5003 instructs that limitation of motion should be rated under the appropriate diagnostic codes for the specific joints involved, unless the limitation of motion of the specific joint involved is noncompensable under those codes, in which case a rating of 10% is applied to a joint affected by limitation of motion, provided the limitation of motion is objectively confirmed by satisfactory evidence of painful motion.  The painful motion in this case was well documented in the NARSUM and was specifically included in the Informal PEB findings.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (Higher of two evaluations), the Board recommends a disability rating of 10% for the chronic right iliopsoas tendinitis 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.  In the matter of the chronic right iliopsoas tendinitis condition, the Board unanimously recommends a disability rating of 10%, coded 5003-5024 IAW VASRD §4.71a and §4.59a.  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 Iliopsoas Tendinitis Condition	5003-5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150006293 (PD201301853)

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						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA