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AF | PDBR | CY2012 | PD2012 01962

Original file (PD2012 01962.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: CASE: PD1201962
BRANCH OF SERVICE: Army BOARD DATE: 20130515

SEPARATION DATE: 20051122

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91W10/Health Care Specialist) medically separated for chronic bilateral hip pain. She experienced the onset of left hip pain during physical training in 2002 and then right hip pain in 2003; both persisted throughout her remaining years of service. 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 hip condition, characterized as “Bilateral hip pain L > R” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded lumbosacral plexopathy, judged to meet retention standards. The Informal PEB (IPEB) adjudicated “Chronic pain of both hips, left greater than right, without a history of trauma” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The lumbosacral plexopathy was determined to meet retention standards. The CI appealed to a Formal PEB (FPEB), but later withdrew her request. An Informal Reconsideration PEB affirmed the initial IPEB findings and ratings. The CI was then medically separated with a 10% disability rating.

CI CONTENTION: “The severity of the conditions have progressively worsened. As a result of the diagnosis made for the left hip and knee, the right side has been compromised due to overcompensation. The right hip now warrants the same diagnosis. Medications are taken on a regular basis in attempts to fend off any debilitating pain. Some of the medications render the SM useless as they cause drowsiness and/or induce sleep. The conditions not only cause physical pain, but the SM suffers emotional anguish as well. SM has school aged children whom she is unable to perform certain activities with, and for, due to the pain that results during and afterwards. SM is unable to run, walk long distances, or stand for prolonged periods without significant pain or even lack of mobility for days at a time resulting. During times of inclement weather, legs ache and mobility is compromised. SM encounters difficulty standing without complication from a seated position, this is to include leisure and everyday functions such as latrine use.”

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 requested knee condition and emotional anguish were not identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board. The rating for the unfitting bilateral hip condition is addressed below. The lumbosacral plexopathy condition, identified as meeting retention standards by the PEB, was not requested for review and thus is not within the defined scope. 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 Recon IPEB – Dated 20050616	VA - (2 Mos. Pre-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Chronic Pain of Both Hips, Lt Greater than Rt	5099- 5003	10%	Degenerative Joint Disease, Lt Hip	5255-5003	0%*	20050930
			Rt Hip Condition	5255	NSC	20050930
Lumbosacral Plexopathy	Meets Retention Standards	Residual Injury t o Pudendal Nerve, S/P Surgical Intervention	8599-8530	0% **	20050930
No Additional MEB/PEB Entries	Other x 8	20050930
Combined: 10%	Combined: 10%

Derived from VA Rating Decision (VA RD ) dated 200 60201 ( most proximate to date of separation [ DOS ] ).
*VARD 20100208 increased left hip to 10% based on exam 20100127 effective 20091002

**VARD 20120503 changed to 8530-8521 and increased to 10% effective 20100623

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Chronic Pain of Both Hips, Left Greater than Right. The CI initially injured her left hip in July 2002 during postpartum physical training. X-ray examination of the left hip, 12 July 2002 revealed “mild rim osteophytosis (bone spurs) of the left femoral head consistent with early degenerative joint disease.” She was treated with Ibuprofen and the pain resolved within a few days. The CI had recurrent episodes of pain, more frequently during her deployment to Afghanistan in October 2002. Upon return, the CI was seen in family practice (FP) due to hip pain and was started on another non-steroidal anti-inflammatory drug, placed on temporary duty restrictions, and later referred to physical therapy (PT). A magnetic resonance imaging (MRI) exam performed on 25 August 2003 revealed a normal appearance of both hips and pelvis. In January 2004, the CI was seen in the FP clinic with complaints of right hip pain. X-ray examination of the right hip on 8 January 2004 was normal and a bone scan of the both hips, on 18 February 2004, was also normal. A PT note on 26 March 2004 reported that the CI continued to experience left hip pain. The examiner noted that the CI had only had aquatic therapy four times due to a busy work schedule and she was still not running; the CI was discharged from PT on that date due to “no progress.” A repeat X-ray of the left hip on 18 July 2004 was unremarkable. The MEB narrative summary (NARSUM) performed on 15 December 2004, 11 months prior to separation and when the CI was 6 months pregnant, noted that the CI’s hip pain was permanently profiled in June 2004. It noted that on 18 July 2004, the CI developed a pain in the left hip during field exercises and was evaluated in the emergency department; she was treated conservatively and given 72 hours quarters. The NARSUM reported that the CI found out she was pregnant the following week. The CI continued to experience pain during her pregnancy. The NARSUM stated that the CI was attending outpatient PT and aquatic therapy, at that time. The MEB examination of the hips revealed no pain with flexion, extension, or internal/external rotation. The examiner noted that the right and left hips had equal range-of-motion (ROM). The PEB was delayed until after the CI had returned from convalescent leave following childbirth. On 10 March 2005, the CI was admitted to the hospital in active labor and had a spontaneous vaginal delivery. The VA Compensation and Pension (C&P) examination was performed on 30 September 2005, less than 2 months prior to the date of separation. The CI denied any interference with her posture or gait with regards to her chronic hip condition. There was no mention of pain. The neurological examination was normal as were the posture and gait. Both hips had normal ROM and outline without atrophy. X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic hip pain, left greater than right, condition analogously to 5099-5003, degenerative arthritis, and assigned a 10% rating. The VA rated the left hip at 0%, using the coding option 5255-5003, impairment of the femur and degenerative arthritis, and determined the right hip to be not service-connected. The VA subsequently increased the disability of the left hip condition to 10%, effective 2 October 2009, due to evidence of painful motion on a C&P performed over 4 years after separation. The Board considered if the hips were separately unfitting, but noted that the MRI, bone scan, and X-rays proximate to separation were normal as was the C&P examination accomplished less than 2 months prior to separation. The Board did note that X-rays of the left hip 3 years prior to separation were consistent with early degenerative joint disease. The evidence in record does not support a separate finding of unfitting for the right hip. The Board found no higher route to a higher compensable rating than that used by the PEB. There was no compensable rating for limitation of motion of the hip (VASRD codes: 5251, 5252, and 5253). 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 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 chronic pain both hips, left greater than right 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
Chronic Pain of Both Hips, L ef t Greater than R igh t	5099-5003	10%
RATING	10%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121211, 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 AR20130010799 (PD201201962)

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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AF | PDBR | CY2012 | PD2012 01962

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