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AF | PDBR | CY2012 | PD2012 01717
Original file (PD2012 01717.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201717
BRANCH OF SERVICE: army  BOARD DATE: 20130515
SEPARATION DATE: 20030711


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated active duty SGT/E-5 (95B/Military Policeman) medically separated for left hip pain. She had a history of chronic left hip pain which resulted in surgery in July 2001. She began to experience pain after 3 months post-operatively and a second surgery was recommended. She declined and continued conservative treatment with activity limitations and modifications. Despite surgical intervention the condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left hip condition, characterized as “left hip pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “left hip pain, snapping hip syndrome” 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.


CI CONTENTION: “I was rated at I0 percent for service connected snapping hip (Left Hip), I have much less range of motion in my left hip. I was rated 0 percent for the scar from the surgery to fix my hip. The scare sit has become hard and at times swollen. I was rated 0 percent for service connected GERD which I know take 2 OMEPRAZOLE 20MG EC CAP twice a day. I was also rated 0 percent for service connected Kidney stones with flank pain. I still get Kidney stones on average of 6 times a year.”


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. Ratings for unfitting conditions will be reviewed in all cases. The rated, unfitting left hip condition meets the criteria prescribed in DoDI 6040.44 for Board purview. The requested scar, gastroesophageal reflux disease and kidney stones conditions were not identified by the PEB, and thus are are 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20030528
 VA - (1 Mos Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Hip Pain 5099-5003 0% Left Hip S/P Release Surgery for Snapping Hip Syndrome 5252 10% 20040601
Scar, Left Hip 7805 0% 20040601
No Additional MEB/PEB Entries
 Other x 5 20040601
Combined: 0%
 Combined: 10%
Derived from VA Ratin g Decision (VARD) dated 200 40710 ( most proximate to date of separation [DOS) .


ANALYSIS SUMMARY:

Left Hip Condition. The record indicates that the CI’s medical condition began in September 2000 when she injured her left hip while conducting company physical training. In spite of treatment to include physical therapy, profile and steroid injections, her pain and the sensation of snapping in her hip continued. She underwent iliopsoas release surgery in July 2001 with only transient improvement in her symptoms. The narrative summary notes that although a second attempt at surgery was discussed, the CI declined and continued to be treated with activity limitations and modifications. At the MEB exam, 3 months prior to separation, the CI reported that her symptoms had worsened to the extent that she was unable to wear her pistol belt which is required of an MP. She was also unable to wear the road gear, load bearing equipment or to ruck march because of pain and the snapping sensation in the left hip. She had difficulty standing for prolonged periods of time at the gate as well as difficulty getting in and out of a vehicle. She described the pain as extending into the left groin and feeling as if the hip was about to pop out. This was most marked when she held her leg in an abducted, externally rotated and flexed position or during any pivoting of the hip. She had not had any dislocations of the hip, and her condition was considered stable. The MEB physical exam noted “a subtle, palpable popping sensation when she brings her hip from an extended to a flexed position.” There was no tenderness to palpation. She had no significant flexion contracture at either hip. Her range-of-motion was recorded as follows: external rotation of both hips was 60 degrees (normal 45 degrees), and abduction was bilaterally 45 degrees (normal 45 degrees). She had some discomfort with the flexion, abduction and external rotation (FABER) maneuver with pain described as being in the hip and not posteriorly. There were no neurovascular problems noted. She was felt to exhibit “activity limiting pain preventing her from performing the duties required of a servicemember of her rank, MOS and station.” The DD Form 2808 (2 months prior to separation) noted difficulty with squatting due to increased pain. The commander’s statement noted that she had received profiles that prevented her from running, performing sit-ups, jumping, standing for long periods of time, and wearing the MP pistol belt. The statement further noted that the CI was severely limited in her ability to perform her duty as a military policeman and that she had by that time been on profile for over 2 years. It was also observed that “she only experiences pain when the hip flexor muscle is irritated by repeated motion or strain.” X-ray studies showed some calcifications around the area of the iliopsoas insertion on the lesser trochanter. Some mild probable disuse osteopenia was noted in the femoral head and the joint space appeared to be well preserved in the hip. At the VA Compensation and Pension exam performed 10 months after separation, the CI reported daily pain with clicking and no other symptoms. The CI stated she had two episodes of subluxation which she was able to manipulate the hip back to the normal position. General C&P examination demonstrated “full range of motion in the hip” with joints C&P exam the same day indicating measured abduction of 25 degrees (normal 45 degrees), without objective sign of pain. There was no edema, effusion, weakness, tenderness, instability or guarding of movements. X-ray showed non-specific calcifications in the tissues adjacent to the proximal femur which was felt to be consistent with possible dystrophic change in the soft tissues. Walking gait was described as linear with very good propulsion. The examiner stated that prolonged walking could produce flare up with increased limitation of motion (estimated 5%).

The Board directs attention to its rating recommendation based on the above evidence. The PEB characterized the hip condition as “left hip pain, snapping hip syndrome” coded analogously as 5099-5003 and rated at 0% for pain described as “moderate, intermittent” likely IAW the USAPDA pain policy. The VA characterized the hip condition as “left hip, status post release surgery for snapping hip syndrome” coded as 5252 (limitation of flexion of the thigh) and rated 10% considering VASRD §4.40 (functional loss) and §4.45 (the joints) concerning function loss due to pain, as cited in DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board considered that the evidence did not support a compensable rating under any of the codes for limitation of motion at the hip (5251, 5252, 5253). However, it concluded that application of VASRD §4.59 (painful motion) was supported by exams and the VASRD §4.40 was supported by both exams and the commander’s statement to achieve the minimum rating (10%) under code 5252 (limited flexion of thigh). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board recommends a disability rating of 10% for the 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. As discussed above, PEB reliance on the USAPDA pain policy for rating left hip pain was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left hip pain condition, the Board unanimously recommends a disability rating of 10%, coded 5252 IAW VASRD §4.71a.


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
Left Hip Pain 5252 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120530, 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 AR20130010839 (PD201201717)
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:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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