RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

                              BRANCH OF SERVICE:  ARMY  
           SEPARATION DATE:  20030314 

 
NAME:  XXXXXXXXXXXXX 
CASE NUMBER:  PD12-00635                             
BOARD DATE:  20121113          
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  Reserve  PVT/E-1  (92A,  Automated  Logistics  Supply)  medically 
separated for bilateral hip and groin pain conditions.  She developed bilateral hip and groin pain 
in  basic  training,  and  was  diagnosed  with  bilateral  femoral  neck  stress  fractures.    The 
orthopedic consultant provided the separate diagnoses listed below.  The conditions could not 
be  adequately  rehabilitated  to  meet  the  physical  requirements  of  her  Military  Occupational 
Specialty (MOS) or satisfy physical fitness standards.  She was consequently issued a permanent 
L3 profile and referred for a Medical Evaluation Board (MEB).  The hip and groin conditions, 
characterized  as  “bilateral  hip  trochanteric  bursitis”  and  “residual  groin  pain  due  to  healed 
femoral  neck  stress  fractures,”  were  forwarded  to  the  Physical  Evaluation  Board  (PEB)  as 
medically unacceptable IAW AR 40-501.  No other conditions were submitted by the MEB.  The 
PEB  (administratively  corrected)  adjudicated  each  condition  as  unfitting;  consolidating  the 
bilateral  hip  condition  under  a  single  code  rated  10%  and  the  bilateral  groin  pain  condition 
under a single code rated 0%, citing criteria of the Veterans Administration Schedule for Rating 
Disabilities  (VASRD).    The  CI  made  no  appeals,  and  was  medically  separated  with  a  10% 
combined disability rating. 
 
 
CI CONTENTION: The application states simply: “The discharge was based on one LOD [line of 
duty determination] for hip injuries.  Did not include another LOD for knees and ankles.”  
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for the unfitting hip and groin conditions 
are addressed below.  The requested knee and ankle conditions were not identified by the PEB, 
and thus are not within the DoDI 6040.44 defined purview of the Board.  Those, and any other 
conditions  or  contention  not  requested  in  this  application,  remain  eligible  for  future 
consideration by the Army Board for the Correction of Military Records. 
 
 
RATING COMPARISON:  
 

Service PEB (Admin Corrected) – Dated 20030214 

Condition 

Bilateral Hip Trochanteric Bursitis 
Residual Groin Pain S/P Femoral 
Neck Stress Fracture 

Combined:  10% 

Code 
5019 
5099-
5003 

Rating 
10% 

0% 

VA  – Effective 20090521 
Code 

Condition 

Bursitis/ Stress Fracture, R Hip 
Bursitis/ Stress Fracture, L Hip 

5019-5255 
5019-5255 

Subsumed with above. 

Combined:  20% 

Rating 
10% 
10% 

Exam 
STR* 
STR 
STR 

*STR = Service treatment record.  No probative post-separation VA evaluations in evidence. 
 

ANALYSIS SUMMARY:  
 
Bilateral  Hip  Condition.    The  CI’s  first  treatment  note  for  her  condition(s)  was  in  April  2001 
noting  that  she  had  awakened  with  radiating  low  back  and  pelvic  pain  after  training  for  an 
obstacle course the previous day with “no overt injury.”  She was managed conservatively, but 
her pain persisted throughout training; and, X-rays eventually demonstrated findings of callous 
formation.  A bone scan in June 2001 was consistent with bilateral femoral neck stress fractures 
as  per  the  MEB  diagnosis.    The  orthopedic  addendum  to  the  narrative  summary  (NARSUM) 
stated  that  the  groin  pain  was  “largely  resolved;”  but,  that  she  had  “developed  significant 
bilateral  greater  trochanteric  area  pain  consistent  with  trochanteric  bursitis.”    The  physical 
exam documented by the orthopedist is excerpted below.  

Remarkable  for  normal  gait.    Bilateral  hip  range  of  motion  -  flexion  120  degrees,  bilateral 
abduction  60  degrees,  bilateral  external  rotation  80  degrees,  internal  rotation  30  degrees 
bilaterally.  She has pain localized to the grater trochanter region greater than the groin.  This 
pain is exacerbated by adduction and internal rotation maneuver of the hips and is bilateral. 

The NARSUM did not characterize the nature and degree of pain, stating only that it prohibited 
running and jumping.  The physical exam noted “mild” tenderness of the sacroiliac joint; and 
pain with pelvic rock, straight leg raise, abduction, and rotation.  Strength and other neurologic 
findings  were  normal.    Although  no  VA  Compensation  and  Pension  (C&P)  examination  was 
performed  proximate  to  separation,  the  VA  rating  decision  referenced  a  letter  from  the  CI’s 
private physician dated 14 February 2009.  The comments in the rating decision describing that 
evidence were as follows, “He stated that you had full ranges of motion but had tenderness on 
internal rotation in both hips and over the greater trochanter in both hips (the right greater 
than the left).  X-rays were negative for any degenerative disease or arthritis.  He confirmed the 
diagnosis made in service.” 
The Board directs attention to its rating recommendation based on the above evidence.  IAW 
VASRD  §4.7  (higher  of  two  evaluations),  the  Board  must  consider  separate  ratings  for  PEB 
bilateral joint adjudications; although, separate fitness assessments must justify each Service 
disability rating.  In this case, both hips were considered to fail retention standards; both were 
implicated  by  the  orthopedic  addendum,  NARSUM,  and  all  clinical  entries;  and,  both  were 
profiled.    Members  concurred  therefore  that  each  hip  should  be  conceded  as  separately 
unfitting;  and,  that  coding  and  rating  features  were  logically  identical.    The  range-of-motion 
measurements cited in the orthopedic addendum were in the normal (or better) range; thus, 
no  compensable  rating  is  achieved  solely  on  the  basis  of  limited  motion.    The  addendum, 
NARSUM,  private  medical  exam  and  outpatient  entries  all  provided  satisfactory  support  for 
application of VASRD §4.59 (painful motion) to achieve the minimal compensable rating (10%) 
under any relevant joint code; or, if rating analogously to 5003 (degenerative arthritis).  The VA 
cited painful motion for its compensable ratings under 5255 (femur, impairment of).  There is 
no applicable joint code available in VASRD §4.71a which would yield a rating higher than 10%.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt),  the  Board  recommends  separate  right and  left  disability  ratings  of  10%  each  for  the 
bilateral hip condition.  The action officer recommended, and the Board concurred with, the 
code 5019 (bursitis) for its clinical compatibility.   
 
Groin Pain Condition.  Although diagnosed and adjudicated distinctly, this condition was in no 
way  differentiated by  functional  impact or  exam  findings.   The  orthopedic  addendum  in fact 
stated  that  it  was  mostly  resolved,  and  the  underlying  stress  fractures  were  radiographically 
healed.    The  profile  was  for  “bilateral  hip  pain”  only.    Although  the  residual  pain  from  the 
fractures  and  the  bursitis  which  developed  afterwards  could  be  separately  diagnosed,  it  is 

difficult to understand how they were teased out for separate fitness adjudications; and, it is 
unequivocally true that they cannot form the basis for separate ratings (as per the VA decision) 
without violation of VASRD §4.14 (avoidance of pyramiding).  The Board (by firm precedence 
and prior legal opinion) does not exercise the latitude of making unfavorable recommendations 
countering a PEB fitness determination, but has no VASRD §4.71a grounding for recommending 
compensable rating of the collateral diagnosis in this case.  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 of the bilateral 
groin 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  bilateral  hip  condition,  the  Board  unanimously 
recommends that each joint be rated as separately unfitting at 10%, coded 5019, IAW VASRD 
§4.71a.  In the matter of the bilateral groin pain 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 recommends that the CI’s prior determination be modified as 
follows, effective as of the date of her prior medical separation. 
 

 

UNFITTING CONDITION 

VASRD CODE  RATING 

Trochanteric Bursitis, Left Hip 
Trochanteric Bursitis, Right Hip 
Residual Groin Pain, Bilateral Femoral Neck Stress Fractures 

5019 
5019 

5099-5003 
COMBINED (w/ BLF) 

10% 
10% 
0% 
20% 

 

 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120603, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20120021441 (PD201200635) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)