RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201440 SEPARATION DATE: 20030616 

BOARD DATE: 20130319 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (31U/Signal Systems Support Specialist), 
medically separated for bilateral hip pain. The hip pain condition began in 2000, improved, but 
then recurred in 2001. It was not a consequence of trauma or associated with a surgical 
indication. Bilateral hip pain could not be adequately rehabilitated to meet the physical 
requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
She was consequently issued a permanent L3 profile and referred for a Medical Evaluation 
Board (MEB). The hip pain, characterized as “chronic hip pain bilaterally,” was forwarded to the 
Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions 
were submitted by the MEB. The PEB adjudicated the bilateral hip pain as unfitting, rated 10%, 
referencing US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, 
and was medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “They have progressively become worse. Right shoulder tendonitis- seems as 
if the pain travels down arm to wrist and hand; making it hard to write and/or use computer 
which is the bulk of my job. Trochanteric Bursitis, left & right hip – very hard to get sleep at 
night; also hard to stand or sit for prolonged periods of time.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military service; or, when requested by the CI, those condition(s) “identified but not 
determined to be unfitting by the PEB.” The rating for the unfitting bilateral hip pain condition 
is addressed below. The requested right shoulder tendonitis was not identified by the PEB, and 
thus is not within the DoDI 6040.44 defined purview of the Board. 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 the Correction of Military 
Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20030228 

VA (4 Mo. Pre-Separation) – Effective 20030617 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Hip Pain due to 
Stress Fracture and 
Reaction 

5099-5003 

10% 

Trochanteric Bursitis, Left Hip 

5019-5252 

10% 

20030221 

Trochanteric Bursitis, Right Hip 

5019-5252 

10% 

20030221 

.No Additional MEB/PEB Entries. 

Right Shoulder Tendonitis 

5299-5203 

10% 

20030414 

0% X 0 / Not Service Connected x 2 

 

Combined: 10% 

Combined: 30% * 



*Includes 1.9% bilateral factor for 5252 codes 

 

 


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment and worsening severity with which her service-incurred 
condition continues to burden her. It is a fact, however, that the Disability Evaluation System 
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. 

 

Bilateral Hip Pain. The PEB combined left and right hip pain as the single unfitting and solely 
rated condition, coded analogously to 5003. Although this approach complies with AR 635.40 
(B.24 f.), the Board must apply separate codes and ratings in its recommendations, if 
compensable ratings for each condition are achieved IAW VASRD §4.71a. If the Board judges 
that two or more separate ratings are warranted in such cases, however, it must satisfy the 
requirement that each ‘unbundled’ condition was unfitting in and of itself. Not uncommonly 
this approach by the PEB reflects its judgment that the constellation of conditions was unfitting; 
and, that there was no need for separate fitness adjudications, not a judgment that each 
condition was independently unfitting. Thus the Board must exercise the prerogative of 
separate fitness recommendations in this circumstance, with the caveat that its 
recommendations may not produce a lower combined rating than that of the PEB. The CI first 
developed hip pain during basic training, which was treated in February 2000. Although the 
narrative summary (NARSUM) reported that this pain was in the right hip, careful review of the 
entire record indicates that she was seen and treated for only left hip pain in basic training. 
Symptoms improved, but left hip pain again developed in August 2001. A bone scan on 
30 August 2001 noted a faint stress reaction and a possible early stress fracture in the left 
inferior pubic ramus. The record was silent regarding any hip pain from November 2001 until 
September/October 2002, at which time she reported "two years of bilateral hip pain." This 
was the first reference to any right hip problem. A follow-up bone scan was performed on 
23 October 2002, which showed possible persistent stress reaction but without definite 
evidence of stress fracture. A profile for bilateral hip pain was first written in October 2002. A 
primary care clinic evaluation on 2 December 2002 (6 months prior to separation) stated that 
the chronic bilateral hip pain was directly related to physical activity (especially running and 
jumping), but that she could do her job except when she went to the field and had to wear a 
Kevlar vest and a rucksack. Examination noted "full ROM" and tenderness of each greater 
trochanter. At the NARSUM exam, 5 months prior to separation, the CI complained of an 
inability to run or jump because of her pain. It was also difficult to sit or walk for prolonged 
periods, or to lift; but she could perform basic activities of daily living. Physical examination 
noted a normal gait and "full range of motion of the hips." Tenderness was present on deep 
palpation of the greater trochanteric areas bilaterally. Pain of each hip was elicited with full 
abduction. At the VA Compensation and Pension (C&P) exam 4 months prior to separation the 
CI noted that her bilateral hip pain was intermittent, could occur as often as every day and 
could last hours until she took Motrin. Pain caused her to walk slowly, but she could climb 
stairs and push a lawn mower. Examination revealed a normal posture and gait. Some 
tenderness at the greater trochanter was present bilaterally. ROM measurements reported 30 
degrees of extension (normal to 20 degrees, although examiner stated normal was 30 degrees), 
adduction of 25 degrees (normal 45 degrees although examiner stated normal to 25 degrees), 
abduction 40 degrees (normal 45 degrees) and external rotation to 50 degrees (normal 45 
degrees but examiner stated normal to 60 degrees). Painful motion was present on abduction, 
external rotation and internal rotation. Flexion was limited to 90 degrees (normal to 125 
degrees), at which point pain was noted. X-rays of the hips were normal. 

 

The Board directs attention to its rating recommendation based on the above evidence. As 
previously elaborated, the Board must first consider whether right hip pain remains separately 
unfitting, having de-coupled it from a combined PEB adjudication. In analyzing the intrinsic 
impairment for appropriately coding and rating the right hip pain condition, the Board is left 
with a questionable basis for arguing that it was indeed independently unfitting. Despite the 


statements just prior to the MEB process that bilateral hip pain was present for 2 years, the 
above evidence indicates that only a left hip problem was documented from the time of basic 
training until the MEB process. After a temporary profile for the left hip expired in 2001, the 
record was then silent regarding any hip issues for approximately 10 months (i.e. shortly before 
the MEB process). After due deliberation, the Board agreed that evidence does not support a 
conclusion that right hip pain, as an isolated condition, would have rendered the CI incapable of 
continued service within her MOS; and, accordingly cannot recommend a separate rating for it. 
Next, the Board turned its attention to the left hip. The VA cited painful motion as the rationale 
for assigning a 10% rating under a combined 5019-5252 code (bursitis; thigh, limitation of 
flexion of). Board members agreed that in the absence of compensable limitation of motion, 
there was sufficient evidence of painful motion (VASRD §4.59) to warrant a 10% rating under 
either the PEB's or VA's coding pathways. The Board determined that there was no route to a 
rating higher than 10% under any applicable hip code. Given the findings regarding the right 
and left hip as just elaborated, the Board concluded that there was no benefit to the CI in 
unbundling the bilateral hip condition. Therefore, 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 bilateral 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. As discussed above, PEB 
reliance on the USAPDA pain policy for rating bilateral hip pain was operant in this case and it 
was adjudicated independently of that policy by the Board. In the matter of the bilateral hip 
pain due to stress fracture and reaction 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 

Bilateral Hip Pain Due to Stress Fracture and Reaction 

5099-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294 dated 20120624, w/atchs. 

Exhibit B. Service Treatment Record. 

Exhibit C. Department of Veterans’ Affairs Treatment Record. 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXX, AR20130005515 (PD201201440) 

 

 

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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)