RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

Service FPEB – Dated 20020715 
Condition 
Left Hip Pain 

Code 
5099-5003 

Rating 
10% 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20021127 

 
NAME:  XXXXXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200886 
BOARD DATE:  20130117    
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PFC/E-3 (95B/Military Police), medically separated for 
mulitfactorial left hip pain.  The CI developed left hip pain in August 2000 during Basic Training. 
She  reported  feeling  a  sudden  pain  when  removing  her  rucksack  during  a  road  march.  
Following an 18-month trial of physical therapy and conservative treatment, she had no relief 
from her symptoms was issued a permanent L3 profile and referred for a Medical Evaluation 
Board (MEB).  The MEB forwarded no other conditions for Informal Physical Evaluation Board 
(IPEB) adjudication.  The IPEB adjudicated the multifactorial left hip pain condition as unfitting, 
rated  at  10%.    The  CI  opted  for  a  Formal  PEB  (FPEB)  that  affirmed  the  IPEB  findings  by 
continuing the rating as multifactorial left hip pain rated at 10% with application of the US Army 
Physical Disability Agency (USAPDA) pain policy.   
 
 
CI  CONTENTION:    “The  Army  Medical  Board  would  not  increase  my  physical  disability  rating 
because I had not been prescribed pain narcotics while in the Army.  At that point all of the 
doctors I saw refused to prescribe me anything more than over-the-counter pain medication 
because I was young, in my early 20's, with a life-long injury and they did not want to run the 
risk of me becoming addicted to the pain medications.  After I was separated from the Army, I 
was  re-evaluated  at  the  Denver  VAMC  and  my  physical  disability  rating  was  increased  even 
though I still had not been prescribed a narcotic pain medication.  A little over one year ago I 
was evaluated once again and my physical disability rating increased again.  I have now been 
prescribed Tramadol, a pain medication; started going to Physical Therapy at the Cheyenne  
VAMC  to  straighten  out  my  pelvis  in  an  attempt  to  reduce  my  pain;  and  have  been  given 
permanent handicap license plates to use when needed.”  
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in 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 unfitting conditions will be reviewed in all cases.  The condition multifactorial left hip pain as 
requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; 
and,  is  addressed  below.    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 Army Board for Correction of Military Records.   
 
 
RATING COMPARISON:   
 

VA (4 Mos. Pre-Separation) – All Effective Date 20021128 
Rating 
Condition 
Left Hip Pain… 
10% 

Code 
5099-5024 

Exam 
20020607 

Combined:  10% 

Combined:  10% 

 
 
ANALYSIS SUMMARY:   
 
Multifactorial Left Hip Pain Condition.  Multifactorial left hip pain refers to pubic ramus stress 
fracture, chronic tendinosis in the thigh adductors and inguinal and sacroiliac ligaments.  The CI 
had  onset  of  left  hip  pain  with  running  in  August  2000  during  basic  training.    X-rays 
demonstrated evidence of a healing stress fracture of the left inferior pubic ramus of the pelvis.  
She experienced recurrent pain with strenuous training activities during 2001 without evidence 
of  new  stress  fracture  on  X-rays.    An  X-ray  11  December  2001  was  interpreted  as  showing 
evidence  consistent  with  an  adductor  muscle  insertion  avulsion  injury  (of  the  hip  adductor 
muscles that attach to the inferior pubic ramus).  At the time of the MEB narrative summary, on 
20 January 2002, the CI reported dull constant pain depending on activity level which increased 
with walking, lifting, and wear of all forms of force protection gear.  The pain was transiently 
decreased while jogging or stretching.  There were no limitations with normal daily activities, 
could sit and stand up to 45 minutes, lift up to 15 pounds and run a maximum of one mile at 
her own pace.  On examination, there was tenderness left inferior pubic ramus and adductor 
muscle  attachments  as  well  as  the  left  anterior  and  posterior  superior  iliac  spine,  and  left 
inguinal ligament.  Examination test maneuvers that stressed the hip joint and sacroiliac joint 
were reported as positive. The range-of-motion (ROM) of the left hip was flexion 120 degrees, 
extension 20 degrees, abduction 45 degrees of abduction, and adduction 20 degrees.  At the 
time of an orthopedic evaluation on 20 May 2002, the CI indicated the pain was located at the 
left groin/inferior pubic ramus.  On examination, there was full active ROM of the hip with pain 
at extremes of motion.  There was mild pain with examination test maneuver that stressed the 
hip joint and sacroiliac joint.  The orthopedic surgeon concluded with diagnosis of chronic left 
pelvic pain, healed left inferior pelvic ramus stress fracture, adductor strain with no significant 
avulsion.  At the VA Compensation and Pension examination, performed 6 July 2002, 5 months 
prior to separation, the CI reported constant pain and weakness in the left hip.  Gait was normal 
(non-antalgic) but the CI was reported to be unable to stand on the left leg and leg strength was 
decreased  compared  to  the  left.    There  was  generalized  tenderness  about  the  hip  and 
examination  maneuvers  that  stressed  the  hip  joint  and  sacroiliac  joint  were  reported  as 
positive.    ROM  of  the  left  hip  after  five  repetitions  was  flexion  100  degrees,  extension  25 
degrees,  abduction  45  degrees,  adduction  20  degrees,  external  rotation  40  degrees,  and 
internal rotation 40 degrees.  The Board directs attention to its rating recommendation based 
on the above evidence.  The PEB and VA chose different coding options for the condition, but 
this did not bear on rating.  The PEB rated the multifactorial left hip pain 10% with application 
of  the  USAPDA  pain  policy  (5099-5003).    The  VA  assigned  a  10%  rating  analogous  to  5024, 
tenosynovitis,  limitation  of  motion  of  affected  part.    There  was  not  limitation  of  motion  all 
examinations warranting a minimum rating under the respective codes for hip/thigh limitation 
of motion (5251, 5252, and 5253).  All members agreed there was evidence of painful motion 
and  decreased  function  warranting  a  rating  of  10%  with  application  of  §4.59  and  §4.40.  
Although there was evidence of multiple tendons about the left hip affecting hip function, the 
contributions of all are subsumed under the single rating for hip disability in accordance with 
§4.14 (Avoidance of pyramiding).  After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was 
insufficient cause to recommend a change in the PEB adjudication for the multifactorial 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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating multifactorial left hip pain condition was operant 
in this case and the condition was adjudicated independently of that policy by the Board.  In the 
matter  of  the  multifactorial  left  hip  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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

UNFITTING CONDITION 
Multifactorial Left Hip Pain 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120611, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXX, AR20130003087 (PD201200886) 
 
 
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 
 
 
 
 
 
 
 
 
 

     XXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)