RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
SEPARATION DATE: 20020917
BRANCH OF SERVICE: ARMY
NAME: XXXXXXXXXXXXX
CASE NUMBER: PD1200709
BOARD DATE: 20121115
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty, PV2/E‐2, (88K/Watercraft Operator), medically
separated for a right hip condition. She suffered a stress fracture of the hip during early
training, for which she underwent surgical pinning. She suffered persistent pain, however; and,
the joint 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 condition was forwarded to the Physical Evaluation Board (PEB) as two diagnoses
(“right hip arthralgia” and “s/p percutaneous femoral neck pinning”) characterized as separate
medically unacceptable conditions IAW AR 40‐501. No other conditions were submitted by the
MEB. The PEB appropriately combined the separate hip diagnoses as a single unfitting
condition (“right hip pain with a history of femoral neck stress fracture”) rated 0%, citing
criteria of the Veterans Administration Schedule for Rating Disabilities (VASRD). The CI made
no appeals, and was medically separated with that disability rating.
CI CONTENTION: The application states simply, “VA rating decision dated May 2, 2003 granted
10%.” She does not elaborate further or specify a request for Board consideration of any
additional conditions.
SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 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 right hip condition is addressed below. 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 Correction of Military Records.
RATING COMPARISON:
Service PEB – Dated 20020614
Code
Condition
Right Hip Pain S/P Stress Fracture
5299‐5255
Single Condition Rated: 0%
VA (6½ Mos. Post‐Separation) – Effective 20020918
Rating
0%
Condition
Right Hip Arthralgia...
Code
Rating
10%
Single Condition Rated: 10%
5299‐5255
Exam
20030403
ANALYSIS SUMMARY:
Right Hip Condition. The CI experienced an onset of right inguinal pain with running during
advanced individual training, and an X‐ray in August 2001 diagnosed a non‐displaced stress
fracture of the femoral neck. She underwent percutaneous surgical pinning the same month,
without complication; and, the discharge note documented “relief of all her preoperative pain.”
A 2‐month post‐operative note documented right hip pain “when actively moved...worsens
with weightbearing but not...when passively moved.” That note documented full range‐of‐
motion (ROM). Although her overall recovery was unremarkable, she continued to experience
pain with various activities critical to her MOS. An entry in May 2002 noted that a permanent
hip profile was indicated. Post‐operative X‐rays demonstrated good fixation and normal
alignment. The orthopedist providing the narrative summary (NARSUM) documented a “well
healed fracture without penetration of the femoral head, pins in place without any evidence of
loosening.” The narrative summary (NARSUM) noted that she “continues to have a great deal
of pain which prevents her from performing her duties” and elaborated, “She is unable to walk
greater than 1 to 1½ miles or run any distance greater than 50 yards prior to having hip pain.”
The physical exam noted a well‐healed incision with no remarkable findings and 5/5 strength of
all thigh muscle groups. Contemporary outpatient notes documented normal gait and
occasionally tenderness over the trochanter. The ROM measurements recorded in the
NARSUM were flexion 110 degrees (normal 125 degrees; minimal compensable 45 degrees),
and normal external rotation and abduction. At the VA Compensation and Pension (C&P) exam,
6.5 months post‐separation, the examiner noted “occasional sharp, shooting pains” which were
“intermittent...but essentially every day”. It was noted that the CI needed to shift her weight
often while sitting, could not tolerate standing longer than 1.5 hours, and “even walking 15
minutes causes her hip to ache.” The VA physical exam commented only on the absence of
edema and presence of pulses. The recorded ROM measurements were flexion 120 degrees,
extension 15 degrees (normal 20 degrees; minimal compensable 5 degrees), normal external
rotation, normal abduction, and adduction 20 degrees (normal 45 degrees; minimal
compensable ‘cannot cross legs’ = ~15 degrees). Neither the C&P nor the NARSUM provided
any directed comments regarding painful motion; and, the only MEB outpatient entry
addressing it was the post‐op note describing pain with active motion as quoted above.
The Board directs attention to its rating recommendation based on the above evidence. Both
the PEB and the VA applied the same analogous code 5255 (femur, impairment of) with
provisions for rating hip disability as a complication of malunion. Although there was no
anatomic malunion in this case, members agreed with the PEB and the VA that the code was
justified as an analogous gauge of hip disability. There was no compensable ROM impairment
for rating under any of the limited motion codes for the hip, and scant evidence for application
of VASRD §4.59 (painful motion) to achieve the minimum compensable rating (barring the
single post‐operative note quoted above). Members did agree, however, that application of
§4.40 (functional loss) was supported to achieve the minimum compensable rating; since, §4.40
states “a part which becomes painful on use must be regarded as seriously disabled”. It was
therefore agreed that the PEB’s 0% rating under 5255, albeit compliant with the rating language
of the code itself, could not be supported IAW VASRD §4.7 (higher of two evaluations). A
minimum compensable rating of 10% was achievable under a variety of alternate codes with
application of §4.40. With this underpinning, it was agreed that analogous application of 5255
was appropriate and that the compensable threshold of 10% for ‘slight’ hip disability was
adequately supported by the evidence (as per the VA opinion). Members further deliberated
the option of a 20% recommendation under 5299‐5255 for ‘moderate’ hip disability; but, it was
agreed that (barring undue speculation) the preponderance of the evidence was better aligned
with ‘slight’ than with ‘moderate’ disability. 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 under VASRD code 5299‐5255.
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 condition, the Board unanimously recommends a
2 PD12‐00709
disability rating of 10%, coded 5299‐5255, 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 her prior medical separation:
Surgical Residuals, Right Hip Stress Fracture
UNFITTING CONDITION
VASRD CODE RATING
5299‐5255
COMBINED
10%
10%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120611, w/atchs.
Exhibit B. Service Treatment Record.
Exhibit C. Department of Veterans Affairs Treatment Record.
SFMR‐RB
XXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXX, AR20120022731 (PD201200709)
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:
3 PD12‐00709
Encl
XXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
4 PD12‐00709
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