RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: Army

CASE NUMBER: PD1100628 SEPARATION DATE: 20041030

BOARD DATE: 20120328

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31E10/Corrections Specialist), medically separated for bilateral hip pain. She did not respond adequately to conservative treatment and was unable to perform within her Military Occupational Specialty (MOS) or meet physical fitness standards. She was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB). Bilateral hip pain was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions appeared on the MEB’s submission. Other conditions included in the Disability Evaluation System (DES) packet will be discussed below. The PEB adjudicated the bilateral hip pain condition as unfitting, rated 0%; with likely application of the USAPDA pain policy and the Veterans Administration Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 0% combined disability rating.

CI CONTENTION: She elaborates no specific contentions regarding rating or coding and mentions no additionally contended conditions.

RATING COMPARISON:

ANALYSIS SUMMARY:

Bilateral Hip Condition. The CI’s bilateral hip pain was attributed to inflammatory changes in the joints and femoral neck caused by systemic joint laxity which existed prior to service (EPTS), but had permanent service aggravation due to repetitive microtrauma of military training. The PEB made no deduction for EPTS and rated both hips as a single condition analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis). The PEB disability description stated: “Bilateral hip pain attributed to inflammatory changes in the joints and femoral neck caused by systemic joint laxity (EPTS), permanently aggravated by repetitive microtrauma of military training.”

The CI had bilateral hip pain since July 2003 and complained of hip dislocations during kneeling firing position and while standing at post. Bone scan showed evidence of positive uptake in the region of the right and left femoral neck, and plain radiographs in February 2004 were normal. There were two range-of-motion (ROM) evaluations in evidence, and the service and Department of Veterans’ Affairs exams showed full pain-free ROMs (hyper mobility in the service exam). The service exam indicated no instability or abnormal hip exam testing and stated: “Physical examination: Relatively unremarkable hip exam with normal bilateral ROM with: negative Patrick’s test, negative Gaenslen’s test, negative side abduction test, negative Milgram test, negative valsalva test, negative iliopsoas stretch test, no evidence of pain to palpation, and can demonstrate normal back ROM with no pain or discomfort. The neurological evaluation is still unremarkable, with a normal motor, sensory, and deep tendon reflex evaluation on lower extremities. No clicking was noticed on ROM for right and left hip and patient did not have any pain at all in doing activities such as isolation on the iliopsoas muscle.” The VA exam performed one month prior to separation indicated full hip ROMs without pain or decreased ROM, or other DeLuca criteria on repetitive motion or provocative tests. Gait was normal.

Record review indicated a bone scan demonstrating increase in activity of the femoral neck region bilaterally (remote from separation); MRI was negative; and plane films were also negative. The commander’s statement indicated incapacitating exacerbations: “During the kneeling firing position she dislocated her hip. She was immediately taken off the range, which produced a safety hazard. Most recently, while working duties at Post (… the CI) was standing at her post when her hip dislocated. She was unable to place her hip back into place therefore she was taken to the emergency room.” There were three emergency room (ER) visits (22 September 2004, 30 September 2003, and 7 April 2003) and one placement on quarters (5 March 2004) related to the hip conditions which appeared to include the incidents noted in the commander’s statement.

The Board carefully examined all evidentiary information available. The VA impression was bilateral hip pain secondary to chronic stress reaction documented by bone scan. The VA rated the bilateral hips at 0% with coding of 5252-5020 which is analogous to (5252) thigh limitation of flexion and (5020) synovitis. The VARD indicated the VA rating was primarily based on ROM that was not painful or pain-limited. All coding options used the criteria from disability code 5003, but analogous coding of 5099-5020 (to synovitis) was considered predominate. There was remote abnormal imaging (bone scan) of the bilateral hips; however, analogous coding under 5020 (synovitis) does not require abnormal x-ray evidence.

The Army PEB and the VA used different coding options for the bilateral hip condition, and both assigned the same 0% rating percentage. All exams documented pain-free normal ROM of each hip; however, neither the narrative summary (NARSUM) nor the VA Compensation and Pension exam delineated the frequency of ER visits or placement on quarters (discussed above). The Board adjudged that there was sufficient evidence in the treatment record of occasional incapacitating exacerbations (ER reports and quarters) to meet the 20% criteria of “involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations.” After due deliberation, considering all of the evidence, and mindful of VASRD §4.3 (reasonable doubt) and §4.40 (functional loss), the Board recommends a separation rating of 20% for the bilateral hip condition.

Remaining Conditions. Other conditions identified in the DES file were back pain and knee pain and swelling. Several additional non-acute conditions or medical complaints were also documented. None of these conditions were significantly clinically or occupationally active during the MEB period, none carried attached profiles, and none were implicated in the commander’s statement. These conditions were reviewed by the action officer and considered by the Board. It was determined that none could be argued as unfitting and subject to separation rating. No other conditions were service-connected with a compensable rating by the VA within 12 months of separation or contended by the CI. The Board therefore has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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. In the matter of the bilateral hip condition, the Board unanimously recommends a service disability rating of 20%, coded 5099-5020 IAW VASRD §4.71a. In the matter of the back and knee conditions, or any other conditions eligible for consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation.

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20110725, w/atchs

Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXX

President

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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation

for XXXXXXXXXXXXXXXXXX, AR20120016988 (PD201100628)

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 XXXXXXXXXXXXXXXXXX

Deputy Assistant Secretary

(Army Review Boards)

CF:

( ) DoD PDBR

( ) DVA