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AF | PDBR | CY2012 | PD2012 00950
Original file (PD2012 00950.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200950
BRANCH OF SERVICE: Army  BOARD DATE: 20130514
SEPARATION DATE: 20021025


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (54B00/BASIC TRAINEE) medically separated for chronic right groin and hip pain. Despite physical therapy and convalescent leave, the condition could not be adequately rehabilitated to meet the physical requirements of completing basic training or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The hip condition, characterized as right inferior pubic ramus stress fracture, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic right groin and hip pain secondary to stress fracture of the inferior pubic ramus as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 0% disability rating.


CI CONTENTION: The CI elaborated no specific contention in her application.


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 groin and hip condition is addressed below; and, no additional conditions are 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 respective Service Board for Correction of Military Records.


RATING COMPARISON:
Service IPEB – Dated 20020925
 VA - (1.5 mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Groin and Hip Pain
 5099-5003 0% Right Inferior Pubic Ramus Stress Fracture 5255 10% 20021216
No Additional MEB/PEB Entries
 Other x 0 20021216
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30121 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Chronic Right Groin and Hip Pain. The CI reported an onset of right hip pain in May 2002 during basic training which was treated with crutches and other conservative measures. A bone scan performed on 6 August 2002 showed healing stress fractures at the junction of the right inferior pubic ramus and the pubic symphysis, and at the junction of the superior pubic ramus with the acetabulum. Range-of-motion (ROM) in evidence is provided in the following table:

Right Hip (Thigh) ROM
 (Degrees)
 MEB ~ 2 Mo. Pre-Sep VA C&P ~ 1 Mo. Post -Sep
Flexion (125 Normal)
 “Full range of motion” 70
Extension (20)
 30
External Rotation (45)
 80
Abduction ( 45)
 30
Adduction (45)
 25
Comment
 +Tenderness + Pain ful motion
§4.71a Rating
 0% or 10% (PEB 0 % ) 10 %

Several outpatient evaluat ions between May- August 2002 consistently documented normal ROM and gait. An outpatient evaluation on 8 August 2002 noted a non-antalgic gait. The narrative summary (NARSUM) on 20 August 2002 ( 2 months prior to separation) reported that the CI’s pain was worsened by prolonged standing, running, jumping, marching, push-ups, sit-ups, strenuous activity, and carrying her backpack. On physical exam, there was pain with palpation of the groin area. She was able to perform a straight leg raise (SLR) . The log roll test was negative for hip joint pain. The assessment was right inferior pubic ramus stress fracture which was “mildly symptomatic.” The examiner reported that there was no evidence of a femoral neck fracture on the bone scan. At the VA Compensation and Pension (C&P) exam 2 months after separation, the CI reported stable, daily pain since the injury which was worsened by prolonged activity on her feet . Physical examination noted a normal gait. Pain occurred near the extremes of motion documented in the above table. The neurologic exam was normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a non-compensable rating under an analogous 5003 code (degenerative arthritis), and cited no loss of ROM as the rationale. The VA’s 10% rating was based on “slight knee or hip disability” under the 5255 code (femur, impairment of). The limitation of motion reported at the VA exam did not meet the respective minimal rating criteria for codes 5251 (thigh, limitation of extension of), 5252 (thigh, limitation of flexion of), or 5253 (thigh, impairment of); and there was no evidence of hip ankylosis or flail joint under codes 5250 or 5254, respectively. The Board agreed that since there was no involvement of the femur, the 5255 coding option was not a good clinical fit. In contrast to the VA exam that documented non-compensable but pain-limited motion, the service exams consistently reported normal ROM and gait. The Board considered that the limited ROM measurements documented at the VA exam were derived from reported pain threshold with motion during an exam performed in the context of expressly providing a basis for disability rating; thus subject to loss of objectivity. A 10% rating for painful motion (§4.59) or pain with use (§4.40) was considered, but a Board majority agreed that service examinations provided insufficient support for this approach, especially in the context of a normal gait and radiographic evidence of healing in a condition that invariably resolves. 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 chronic right groin and 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 5099-5003 was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic right groin and hip pain condition, the Board by a vote of 2:1 recommends a disability rating of 0%, coded 5099-5003 IAW VASRD §4.71a. The single voter for dissent (who recommended a 10% rating) chose not submit a minority opinion.


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
Chronic Right Groin and Hip Pain
 5099-5003 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120608, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010950 (PD201200950)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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