Author: JOHN J. D'ORAZIO
Last saved by: WEATHERS, JANICE R SrA USAF AFRBA AFRBA/AFBCMR
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxxxx	 CASE:  PD 13-00327	
BRANCH OF SERVICE:  Army 	 BOARD DATE:  20130828
SEPARATION DATE:  20070723		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63B, Wheel Vehicle Mechanic) medically separated for a right hip condition.  He was initially injured in Iraq in 2005 diving for cover during a mortar attack, with pain complaints since that injury.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) or physical fitness standards.  He was, therefore, issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right hip condition, characterized as “right hip DJD” and “right hip acetabular tear”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition, adjustment disorder, medically acceptable.  The PEB adjudicated “right hip pain as unfitting, rated 0%.  The remaining condition was determined to meet medical retention standards.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Reason rating should be changed are as follows, when originally rated by us army peb, was given a 0 (zero) percent rating for following issues, 1) right hip did, 2) right hip acetabular tear, and no rating on 3) adjustment disorder was evaluated by dept. VA, on original rating decision date of 20070730, was given initial ratings of 10% for right hip DJD/acetabular tear, and a 30% rating for PTSD ( claimed as adjustment disorder).  Found that original diagnosis for adjustment disorder was PTSD, was whited out, and changed to adjustment disorder on PEB cover sheet DA3947, is observed due to different font used to describe Item 3, compared to fonts on other 2 items.  Also found inconsistences in stories in narrative summaries for adjustment disorder claiming no medication was ever given, and a conflicting original diagnosis of PTSD, to current standing adjustment disorder, later diagnosed as PTSD by Dept. VA.   

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 Service rating for the unfitting right hip condition is addressed below.  The Board noted that the Adjustment Disorder condition is not a physical disability under DoDI 1332.38 and therefore, not ratable and will be discussed no further.  PTSD was not identified by either the MEB or PEB and therefore, is not in the purview of this Board.  Any conditions or contention, including mental health, 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 PEB – Dated 20070119 | VA - (6 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Right Hip Pain… | 5299-5003 | 0% | R Hip Degenerative Joint Disease & Acetabular Tear | 5252-5010 | 10% | 20070109
Adjustment Disorder | Meets Medical Retention Standards | Post-Traumatic Stress Disorder | 9411 | 30% | 20061212
No Additional MEB/PEB Entries | Other x 7 |
Combined:  0% | Combined:  60%
Derived from VA Rating Decision (VARD) dated 20070730.  

ANALYSIS SUMMARY:  The Board acknowledges the CI’s assertions that his Service disability disposition contained improprieties.  It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations.  These issues may be addressed by the Board for the Correction of Military Records and/or the United States judiciary system.

Right Hip Pain.  The Narrative summary noted in May 2005 the CI injured his right hip after diving for cover during an attack.  Since then he has suffered mechanical pain involving the right hip region diffusely in the buttock, lateral hip and groin.  Magnetic resonance imaging (MRI), 20 July 2006, approximately one year prior to separation, showed an anterior labral tear of the right hip without loose body or cartilage defect and a small cyst in the femoral head.  Small joint effusions were noted bilaterally without evidence for avascular necrosis or trochanteric bursitis.     Treatment records indicated the CI was treated with medication for pain and participated briefly in physical therapy (PT) for hip and back pain.  The CI was offered surgery to address the labral tear, but declined.  Review of treatment notes indicated three entries with painful motion and two with limited motion of the right hip.  At the MEB NARSUM evaluation, 10 August 2006, 13 months prior to separation, the CI reported right hip pain.  He stated he was unable to take the PT test due to his condition.  On physical exam of the right hip, tenderness to palpation in the right groin, mild tenderness to palpation hip musculature, and minimal tenderness to palpation over the hip bone were noted.  Pain was noted with flexion of the hip;   normal muscle strength and normal sensory function were recorded.  The physician reference the ROM measured at PT 31 July 2006, which recorded decreased right hip flexion of 90 degrees with increasing ROM ability on repetition (no Deluca).  The VA Compensation and Pension (C&P) evaluation, 9 January 2007, approximately seven months prior to separation, recorded history of right hip/DJD, pain and restricted ROM.  Physical examination of the right hip noted tenderness to palpation, especially with repetitive motion, and tenderness was elicited in multiple areas involving the hip joint and the buttock.  ROM recorded flexion of 80 degrees active and 100 degrees passive, extension of 30 degrees with noted pain on repetitive motion.  There was no weakness or fatigability.  The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition analogously 5003 at 0% and the VA coded the condition 5252-5010 (traumatic arthritis limitation of flexion) and assigned 10% rating.  The Board considered the limitation of thigh motion codes 5251, 5252, and 5253 but found no evidence in the treatment record to support the application of any of these codes.  Although limitation of motion on flexion was recorded in the record, a 10% rating under the 5252 code requires flexion limited to 45 degrees and 5251 or 5253 requires extension limited to five degrees or abductor/rotation impairments, respectively, none of which were supported by the record in evidence.  There were no other coding options for consideration.  The Board adjudged that the record sufficiently documented pain on motion for application of VASRD §4.59 (painful motion).  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 right 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.  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 right hip pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 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
Right Hip Pain | 5099-5003 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
	           xxxxxxxxxxxxxxxxxxx, DAF
	           President
	           Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB / xxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130021840 (PD201300327)

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						     xxxxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD 13-00327