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AF | PDBR | CY2012 | PD2012 01941
Original file (PD2012 01941.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201941
BRANCH OF SERVICE: Army  BOARD DATE: 20130808
SEPARATION DATE: 20080516


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (92G30/Food Services Specialist) medically separated for a left hip condition. The CI had onset of left hip pain in 2007; without a history of trauma. The hip condition could not 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 underwent a Medical Evaluation Board (MEB). The condition characterized as left hip labral tear was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501. The MEB also forwarded three other conditions (see rating chart below) for IPEB adjudication. The IPEB found him “fit for duty within the limitations of the profile.” The CI did not accept the IPEB findings and requested a formal hearing. The Formal PEB (FPEB) found the hip condition unfitting, and rated it 10% IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD). The other three MEB conditions were all found not unfitting. The CI made no further appeals, and was medically separated.


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 hip condition is addressed below. No other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.


RATING COMPARISON:

Service FPEB – dated 20080313
 VA – (12 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Hip Anterior and Inferior Labral Tear with Hip Pain
 5099-5003 10% Left Hip with Anterior Labral Tear 5252 10% 20090109
Bilateral Knee Pain/Patellofemoral Pain Syndrome
 Not Unfitting Right Knee Pain with Vertical Tear of Medial Meniscus with Mild Osteoarthritis 5258-5010 10% 20090109
Horizontal Tear Posterior Horn Medial Meniscus (Left Knee) 5256 NSC 20090109
Atypical Chest Pain and Benign Hypertension
 Not Unfitting No VA Entry for Chest Pain or Hypertension
No Additional MEB/PEB Entries
 Other x 4 20090109
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 90505 (most proximate to date of separation )


ANALYSIS SUMMARY:

Left Hip Pain. In 2007, the CI developed hip pain. He was treated, but his hip pain persisted. It was determined that he was unable to fully perform his required military duties as a result, a MEB was initiated. His MEB clinical evaluation was on 12 October 2007. In the narrative summary, the examiner noted tenderness over the greater trochanter, left groin region, and posterior aspect. There was no quadriceps or hamstring atrophy. Patrick’s test was positive. Out-toeing was approximately 25 degrees. Active range-of-motion (ROM) was measured with goniometer, and is summarized in the chart below. Magnetic resonance imaging (MRI) showed an anterior superior labral tear. The MRI findings were consistent with femoral acetabular impingement. Hip surgery was recommended, but the CI declined surgical intervention. As noted above, the FPEB found him unfit for military duty, and the CI was medically separated from service on 16 May 2008. Eight months later, on 9 January 2009, he had a VA Compensation and Pension exam. Posture and gait were normal. There was slight tenderness of the left hip, but no redness, warmth, edema, crepitus, or gross deformity. The left hip was painful to motion. The two ROM evaluations which the Board weighed in arriving at its recommendation are summarized below.

Left Hip ROM
 MEB ~ 7 M os . Pre-Sep
 (20071012) 		VA C&P ~ 8 M os . Post-Sep
 (20090109)
Flexion (125 ⁰ is n ormal)
 100 ⁰ 115 ⁰
Extension
 0 ⁰ 0⁰
External Rotation
 35 ⁰ 50 ⁰
Abduction ( 45 ⁰ is normal )
 30 ⁰ 35 ⁰
Adduction
 35 ⁰ 25 ⁰
Comment
 Painful motion Painful motion
§4.71a Rating
 10 % * 10 % *
*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The FPEB and the VA chose different coding options for the left hip condition, but both assigned a disability rating of 10%. The FPEB used VASRD code 5099-5003 (analogous to degenerative arthritis). The VA chose diagnostic code 5252 (thigh, limitation of flexion of). Using the information in the treatment record, the Board determined that the CI’s left hip was essentially non compensable based on the VASRD §4.71a codes for loss of hip/thigh motion (5250 through 5253). However; IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. The Board tried to find a path to a higher rating for the left hip, but there was not sufficient evidence of a significantly disabling hip condition to justify a rating greater than 10%. The Board unanimously agreed that; IAW VASRD §4.40, §4.45, §4.59, and §4.71a, a disability separation rating of 10% was warranted for the left hip condition. 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 FPEB adjudication for the left 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. 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 left hip condition and IAW VASRD §4.40, §4.45, §4.59, and 4.71a; the Board unanimously recommends no change in the PEB adjudication.
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
Left Hip Anterior and Inferior Labral Tear with Hip Pain
 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121203, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130019920 (PD201201941)

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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