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AF | PDBR | CY2012 | PD2012 01535
Original file (PD2012 01535.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx        CASE: PD1201535
BRANCH OF SERVICE: MARINE CORPS       BOARD DATE: 20130430
Separation Date: 20030831


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (6462, Avionics Test Set (ATS) Technician) medically separated for a left hip condition. The CI developed left hip pain during boot camp in September 1999. Despite a limited duty (LIMDU), non-steroidal anti-inflammatory drugs (NSAIDs), pain medication, orthopedic, pain management, and rheumatology evaluations, the CI failed to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. The CI was referred for a Medical Evaluation Board (MEB). The MEB forwarded acute synovitis left hip, undetermined etiology; status post (s/p) arthrocentesis and intra-articular steroids; and s/p diagnostic arthrogram and magnetic resonance (MR) left hip to the Physical Evaluation Board (PEB). The PEB adjudicated acute synovitis left hip, undetermined etiology as unfitting, rated 10%, with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB also adjudicated s/p diagnostic arthrogram and MR left hip and s/p arthrocentesis and intra-articular steroids” as Category III (conditions that are not separately unfitting and do not contribute to the unfitting condition). The CI made no appeals, and was medically separated.


CI CONTENTION: “The conditions for which I was released from the Marine Corps and given a VA disability rating have progressively gotten worse over the last nine years.”


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 left 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 Board for Correction of Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20030711
 VA - (~6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Acute Synovitis Left Hip 5299-5003 10% Residuals, Left Hip Synovitis 5251-5020 10% 20040220
S/P Diagnostic Arthrogram and MR Left Hip Category III
S/P Arthrocentesis and Intra-Articular Steroids Category III
No Additional MEB/PEB Entries
 Other x 4 20040204
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VARD) dated 20040427 ( most proximate to date of separation [DOS]).


ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation System fitness determinations and rating decisions for disability at the time of separation. The Board utilizes service and VA evidence proximal to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for special consideration of post-separation evidence. Post-separation evidence is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Acute Synovitis Left Hip, Undetermined Etiology Condition. There were range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Hip (Thigh) ROM
(Degrees)
 MEB ~ 5 Mo. Pre-Sep Ortho ~ 3 Mo. Pre-Sep VA C&P ~ 6 Mo. Post-Sep
Flexion (125 Normal)
 No ROM FROM
125 (130 , pain at 120 )
Extension (20)
 20 (30)
External Rotation (45)
 45 (60)
Abduction (0-45)
 45 (60)
Adduction (45)
 20
Comment
 Painful Left hip; pain extending fro m groin into left anterior thigh ; “ very irritable in all directions ” “ongoing pain”; Slight irritable with pain on Internal rotation No change with Deluca; pain with flexion 120-130; strength 5/5; slight pain on palpation ; slight limp
§4.71a Rating
 10 % 10 % 10 %

The CI had a well-documented history of left hip pain with motion in the service treatment record. The left hip pain worsened and precipitated an emergency room visit with a four day admission for left hip acute synovitis in December 2002 . During this admission, the CI underwent two left hip arthrocentese s with intra - articular steroids . The CI was seen by rheumatology who noted a functional impairment of an inability to participate in physical training or lift heavy objects due to left hip pain and physical exam findings of left hip pain on all extremes of ROM. A left hip post- arthrogram MR was normal. The MEB narrative s u mmary (NARSUM) examination approximately five months prior to separation indicated that the CI had been on LIMDU and had pain with any amount of pressure that had a poor response to NSAIDS and pain medication. The MEB NARSUM physical exam findings are summarized in the chart above. The non-medical assessment indicated an inability to lift objects that weighed more than fifteen pounds, an inability to stand more than ten minutes inability to do excessive walking , and an inability to participate in her training events. The CI was evaluated by o rthopedics for ongoing left hip pain approximately three months prior to separation . The o rthopedic physical exam findings are summarized in the chart above. A b one scan done to rule out rheumatoid changes was negative. The VA Compensation and Pension (C&P) examination completed approximately six months after separation documented left hip pain, stiffness , and weakness with end of the day flares on a daily basis lasting until bedtime . No assistive devices were used. At the time of the C&P exam, the CI was six months pregnant and was not taking any medications. The C&P physical exam findings are summarized in the chart above.

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the acute synovitis left hip analogous to 5003 arthritis, degenerative (hypertrophic or osteoarthritis) rated 10%. The VA coded the residuals, left hip synovitis 5251 thigh, limitation of extension of with 5020 synovitis rated 10%. The PEB and the VA chose different coding options; however, this did not materially affect the rating. Neither coding is predominating and all exams support a 10% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the acute synovitis left 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 acute synovitis left hip 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
Acute Synovitis Left Hip 5299-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120820, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         xxx
         Director of Operations
         Physical Disability Board of Review


MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 15 Jul 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USMC
- former USMC
- former USMC
- former USN
- former USN
- former USN



                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)
                                                     



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