Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01638
Original file (PD2012 01638.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201638
BRANCH OF SERVICE: Army  BOARD DATE: 20130514
SEPARATION DATE: 20030503


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (97E/Interrogator) medically separated for chronic right hip pain. CI was struck by a car in Oman on 21 February 2002. He had fractures in the right femur, pelvis, and facial bones; and was evacuated to Landstuhl, Germany where he had a nailing of the femoral fracture. The CI was placed on 6 months of convalescent leave. He participated in physical therapy but was unable to be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board. The chronic right hip pain condition was found medically unacceptable, and was forwarded to the Physical Evaluation Board IAW AR 40-501. The MEB also identified and forwarded five other conditions, recurrent Fuchs heterochromic iritis, vision defect, right testicular atrophy, residual numbness and pain anterior maxilla, and high frequency hearing loss, left ear for PEB adjudication. The Informal PEB adjudicated chronic right hip pain as unfitting, rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not unfitting . The CI made no appeals, and was medically separated with a 10% disability rating.


CI’s CONTENTION: The CI elaborated no specific contention in his 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 chronic right hip pain condition is addressed below. No other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in his application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20030121
 VA - (1 mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Hip Pain 5099-5010 10% Residuals Status Post Fracture of Femur and Acetabulum Right Hip with Operative Reduction and Internal Fixation 5299-5255 20% 20030416
No Additional MEB/PEB Entries
Other x 6
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30509 ( most proximate to date of separation [ DOS ] )



ANALYSIS SUMMARY:

Right Hip Pain. In February 2002, the CI was struck by a motor vehicle in Oman. He suffered facial fractures, right femur fracture, and right hip acetabular fracture. He was aeromedically evacuated and subsequently underwent open reduction/internal fixation of his fractures. Postoperatively, he recovered substantially and resumed ambulation. However, his right hip pain persisted, and an MEB was initiated. At his orthopedic evaluation performed in August 2002, the CI reported constant pain in his right hip. Increased activity increased the pain. He required the use of a cane, and had an antalgic gait. Neurovascular examination of the extremities was normal. Radiographs of the pelvis showed a well-healed acetabular fracture with maintenance of the joint space. The MEB physical examination performed in December 2002. The CI required a cane for ambulation greater than 1/8 of a mile. He was unable to tolerate impact activities, or sitting in one position for more than 5 minutes. Exam showed no tenderness to pressure about the hips except over the right sciatic area. Range-of-motion (ROM) of the right hip was measured, and is summarized in the chart below. He was able to cross his legs without difficulty. A detailed neurological examination was unremarkable.

At the VA Compensation and Pension exam performed 2 weeks prior to separation, the CI reported that he was unable to do any lifting or carrying, and was unable to perform yard work. He walked with a moderately antalgic gait using a cane. Muscle strength and deep tendon reflexes (DTRs) were normal. The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.


Right Hip ROM
 MEB – 5 mos. Pre-Sep
(20021219)
VA C&P – 2½ weeks Pre-Sep
(20030416)
Flexion (125⁰ is normal)
 120⁰ 115⁰
Abduction (45⁰ is normal)
 35⁰ 25⁰

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Army PEB and the VA chose different coding and rating options for the right hip condition. After a thorough review of the service treatment record, the Board determined that IAW the Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.71a, an appropriate diagnostic code for the right hip condition was 5299-5255 (impairment analogous to malunion of the femur). The Board also determined that the CI’s hip disability was best described as “moderate.” There was not sufficient evidence in the treatment record to support classifying the hip disability as “marked.” The Board tried to find a path to a higher rating using other codes which could be applied to the right hip disability. The other VASRD codes that were considered did not result in a higher rating, since the STR did not show sufficient evidence of a significantly disabling hip abnormality which would justify a higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (resolution of reasonable doubt), the Board recommends by majority decision (2:1 vote) a rating of 20% for the chronic right hip condition. It is appropriately coded 5299-5255, and IAW VASRD §4.71a, meets criteria for the 20% rating level due to moderate hip disability.


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 may have been operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic right hip condition, the Board majority (2:1 vote) recommends a disability rating of 20%, coded 5299-5255, IAW VASRD §4.71a. The single voter for dissent (who recommended no change in the PEB adjudication) did not elect to submit a minority opinion. 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 his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic right hip pain, with loss of motion 5299-5255 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120823, 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 AR20130012148 (PD201201638)
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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02642

    Original file (PD-2013-02642.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.TheInformal PEB adjudicated “pelvic ring fracture” and “left femur fracture,” conditions, rated at 10% and 10% respectively. It is noted, however, that the VA subsumed the acetabular fracture with the hip rating. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record

  • AF | PDBR | CY2014 | PD-2014-02473

    Original file (PD-2014-02473.rtf) Auto-classification: Denied

    Left hip. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Left Hip Pain5299-525510%Residuals, Left Femoral Neck Fracture525520%20090504Other x 0 (Not In Scope)Other x 8 RATING 10%RATING: 30% *Derived from VA Rating Decision (VARD)dated 20090731(most proximate to date of separation (DOS)). Left Hip Pain.

  • AF | PDBR | CY2011 | PD2011-01056

    Original file (PD2011-01056.docx) Auto-classification: Denied

    The MEB forwarded right hip pain secondary to femoral neck stress fracture and left sacroilitis condition on the DA Form 3947 to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. An MRI done at that time noted no evidence of a left hip stress fracture. The CI was seen in follow up by Orthopedics for left hip pain in January 2009 with findings of a positive impingement test in the anterior and posterior left hip and it was noted that the more the CI walked, there...

  • AF | PDBR | CY2013 | PD2013 00113

    Original file (PD2013 00113.rtf) Auto-classification: Denied

    The rating for the unfitting left hip condition(with consideration for the possibly associated degenerative arthritis and“radiating nerve pain down my left leg” as referenced in the contention)is addressed below. The service treatment record (STR) documented significant activity limitations and a limp with the use of a cane. 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...

  • AF | PDBR | CY2014 | PD-2014-02079

    Original file (PD-2014-02079.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The examiner noted X-rays of both hips performed on 12 August 2009 were normal.At the VA Compensation and Pension (C&P) examination on 29 October 2009, 9 months after separation, there was full ROM of both hips with...

  • AF | PDBR | CY2012 | PD2012 00718

    Original file (PD2012 00718.rtf) Auto-classification: Denied

    The InformalPEB (IPEB) adjudicated the left hip pain as unfitting, rated 10%, with cited application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).The remaining (right) leg pain condition was determined to be CategoryII (conditions that contribute to the unfitting condition).The CI made no appeals and was medically separatedwith a 10% disability rating. Under any appropriate VASRD code, the disability evaluation would result in a 10% rating as granted by the PEB. ...

  • AF | PDBR | CY2013 | PD2013 00212

    Original file (PD2013 00212.rtf) Auto-classification: Denied

    The C&P joints exam noted a hip strength of 1/5 due to pain; the C&P general examination a week later noted no muscle atrophy and a normal motor examination.The various examination findings suggest that the CI’s abnormal gaitwas due to pain from the hip, rather than muscle weakness or motor nerve injury. On exam there was tenderness of the anterior, lateral and posterior left thigh and the examiner noted the CI’s paresthesias to have hyper-esthetic and “pins and needles” components.The...

  • AF | PDBR | CY2012 | PD2012 00807

    Original file (PD2012 00807.rtf) Auto-classification: Approved

    The Board agreed the TDRL rating recommendation would be based from the MEB evidence and the post-TDRL recommendation would be based from the VA evidence. The Board agreed the TDRL rating recommendation would be based from the MEB evidence and the permanent rating recommendation would be based from the VA evidence. In the matter of the left femur fracture condition, the Board unanimously recommends a disability rating of 10% at the time of TDRL placement and at permanent separation coded...

  • AF | PDBR | CY2012 | PD2012-01143

    Original file (PD2012-01143.pdf) Auto-classification: Approved

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201143 SEPARATION DATE: 20021215 BOARD DATE: 20130205 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (31U10/Signal Support Systems Specialist) medically separated for chronic pain after surgical pinning of her left femoral neck stress fracture. Her left hip condition could not be...

  • AF | PDBR | CY2013 | PD 2013 01220

    Original file (PD 2013 01220.rtf) Auto-classification: Approved

    The hip condition, characterized as “right hip pain secondary to femoral neck stress fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501, with no other conditions submitted by the MEB.The PEB adjudicated “chronic right hip pain…”as unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.The CI made no appeals and was medically separated. All hip exams in evidence proximate to separation indicated pain with motion,...