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AF | PDBR | CY2013 | PD-2013-01274
Original file (PD-2013-01274.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-01274
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140813
SEPARATION DATE: 20040505


SUMMARY OF CASE: T he available evidence of record reflects that this covered individual (CI) was an active duty OS3 /E- 4 ( Operation Specialist ) medically separated for left lower extremity discomfort . The condition could not be adequately rehabilitated to meet the requirements of her rating or physical fitness standards, so she was placed on limited duty and referred for a Medical Evaluation Board (MEB). “L eft lower extremity discomfort” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “ left lower extremity discomfort” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “No treatment is available for injury. Injury continues to get worse. Member unable to live life fully without constant pain.”


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 left lower extremity condition is addressed below, and no additional conditions are 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 Naval Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.


RATING COMPARISON :

Service IPEB – Dated 20040325
 VA - (1.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Lower Extremity Discomfort 5299-5242 10% Chronic Hip Pain, Left 5299-5250 NSC 20040615
Tear of L5-S1 Lumbar Disc 5299-5236 20% 20040615
Other x 0 (Not in Scope)
 Other x 0
Rating: 10%
 Rating: 20%
Derived from VA Rating Decision (VA RD ) dated 200 40707 .



ANALYSIS SUMMARY:

Left Lower Extremity Discomfort Condition. The CI developed left hip pain in September 2001. The initial clinic encounter for left hip pain, on 25 September 2001, recorded onset after physical training in boot camp. Examination and X-rays were normal. On 6 November 2001, the CI was evaluated by orthopedic surgery due to recurrent left hip pain with running and battle stations exercises. On examination of the hip and back, there was no tenderness and range-of-motion (ROM) was full. There was mild pain with hip motion and a provocative test localized the pain to the hip. Gait was normal. Repeat X-rays performed on 6 November 2001 were normal. At the time of follow-up with orthopedics performed on 30 April 2002, the CI reported persisting left hip pain on the lateral aspect (on the side). There was no specific injury and no associated numbness, tingling or weakness. There was no complaint of back pain. Examination of the left hip was normal except for tenderness of the greater trochanter of the left hip consistent with greater trochanteric bursitis. The orthopedic examination on 24 June 2002, again recorded lateral hip pain with intermittent popping and clicking symptoms of the hip. Provocative examination testing localized the pain to the hip. There was also pain with hip motion that would not be expected to trigger pain from a back source. There was no mention of associated back pain. Magnetic resonance imaging (MRI) of the left hip on 27 June 2002 and bone scan on 3 July 2002, were normal showing no abnormality. Physical therapy evaluation on 30 September 2002 and orthopedic evaluations on 5 December 2002 and 9 January 2003 recorded complaint of lateral hip pain with rare intermittent snapping sensation with tenderness over the greater trochanter consistent with greater trochanteric bursitis. There is no reference to complaint of back pain. The examinations also recorded a normal gait, full motion, normal strength and sensation. A 14 February 2003 clinic encounter records increased left hip pain after scrubbing floors. At the time of examination on 20 February 2003, the CI checked “No” to problems with back pain. A physical therapy evaluation performed on 16 June 2003, recorded complaint of constant left hip pain which was 50% improved with a hip block at an outside civilian provider. On examination, trunk (back) motion was normal (“completely full”; flexion reached to the deck, side bending reached fibular heads at the knees, extension 150% of normal). Hip motion was normal. Straight leg raising was to 70 degrees on the right and 80 degrees on the left without difficulties. Strength was normal. The physical therapist concluded there was no clinical evidence of spine, hip or other lower extremity abnormalities and recommended an exercise program. The MEB narrative summary performed on 27 January 2004, noted the CI had been evaluated at a civilian pain clinic where hip injections did not result in improvement and the pain specialist concluded the back, not the left hip, was the source of pain. On examination there was tenderness over the left buttock region. Left hip ROM was flexion 110 degrees, abduction 30 degrees, adduction 20 degrees, external rotation 60 degrees and internal rotation 40 degrees. A clinic examination performed on 27 January 2004, recorded a normal gait with similar ROMs. A pain clinic record on 24 February 2004, reported results of a discogram on 14 February 2004 showing an annular tear of the L5-S1 disc without herniation. Provocative injection at that site reproduced low back and left hip pain. Injection with local anesthetic temporarily improved the pain. At the VA Compensation and Pension (C&P) examination dated 15 June 2004, a month after separation, the CI reported low back pain radiating into the left hip without a specific history of injury. The pain limited activity including running, walking and riding in a car more than 45 minutes. On examination, the gait was observed as stiff. Hip motion was normal. Thoracolumbar ROM was limited, more than 30 but less than 60 degrees of flexion. The neuromuscular examination of the lower extremities was normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left lower extremity discomfort 10% coded 5299-5242 (analogously to degenerative arthritis of the spine) noting the results of the discogram and pain specialist’s opinion. The VA rated the condition 20% as tear of lumbar disc, coded 5299-5236 (sacroiliac injury and weakness) citing the post separation C&P examination. The Board noted the uncertainty regarding the cause of the CI’s left hip pain. Imaging of the hip (X-ray, bone scan and MRI) was normal. The civilian discogram was reported to show an annular tear at L5-S1. When that location was provocatively injected, pain was reported in the region of the left hip. The Board notes however that annular tears are not clearly associated with back pain and findings of annular tears on imaging are not necessarily indicative of the cause for back pain. The presence of abnormalities on discography does not reliably correlate with the cause of pain and the procedure is not currently recommended by the American Pain Society as a procedure for diagnosing low back pain. The examinations by orthopedic surgery and physical therapy in the service treatment record (STR) were most consistent with a common hip condition, bursitis of the hip and showed no clinical indications of a back condition. The hip examinations did not support a minimum rating under the VASRD diagnostic codes for hip and thigh (5250 to 5255). A 10% rating would be supported for functional loss (§4.40) providing no rating benefit to the CI. Both the PEB and VA rated the condition under VASRD diagnostic codes for the back. The back ROM in the STR was indicated as normal; while the post-separation VA C&P examination recorded limitation was rated at 20% by the VA. The Board noted the results of the C&P examination was inconsistent with the examination findings documented in the STRs. The Board concluded the preponderance of evidence of the STR did not support a rating higher than the 10% adjudicated by the PEB when considered under the spine guidelines. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left lower extremity discomfort 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. In the matter of the left lower extremity discomfort 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 there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130910, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record









                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 12 Feb 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)


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