Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01756
Original file (PD-2013-01756.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD -20 1 3 - 0 1756
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0108
Separation Date: 20041209


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92G/Food Service Specialist) medically separated for left hip pain. The left hip pain 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 referred for a Medical Evaluation Board (MEB). The left hip pain condition, characterized as “left hip pain secondary to hip flexion strain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “left hip pain status post (s/p) injury in Aug 04” as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “Was told I should heal in time, but I haven’t. I suffer from pain in my hip that radiates down to my foot, left side of my body. I have trouble standing long periods and cannot cross my legs. Running is out of the question. I wish this wasn’t so, but they haven’t considered any change in my rating. Also my stress fractures are the… [Unreadable]” [sic]


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 hip pain condition is addressed below. The contended stress fractures were not mentioned by the MEB or PEB and are therefore not within the Board’s scope. 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 Military Records.


RATING COMPARISON :

Service IPEB – Dated 20041122
VA - Based on Service Treatment Records (STR)
Condition
Code Rating Condition Code Rating Exam
Left Hip Pain 5022 0% s/p Flexor Strain; Left Hip 5399-5314 10%* STR
Other x0
Other x0
Rating: 0%
Combined: 10%
Derived from VA Rating Decision (VARD) dated 20041222 (most proximate to date of separation [DOS])
*In 2014, the VA add ed 3 additional conditions related to the left hip ; however, the 10% combined rating stayed the same


ANALYSIS SUMMARY : The Board acknowledges the CI’s contention regarding the significant impairment with which his service-connected condition continues to burden him; 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. The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Left Hip Pain S/P Injury Condition . The CI developed left hip pain after he tripped and hyperextended his hip during a road march after his third week of training. The CI was evaluated in medical clinic for left side pain, which included his hip, knee, and ankle. The physical exam findings were left hip pain with compression and heel strike. The examiner ordered crutches, no weight bearing, and X -rays . A b one scan demonstrated stress reaction in the left hip (source document not in the evidence present for review). Left hip X -rays were normal . The CI was placed on a 30-day convalescent leave to rest the left hip. The o rthopedist noted left hip flexor strain with improvement after convalescent leave; however , the CI reported continued left hip pain with running. The physical exam findings were pain with left hip internal rotation and flexion, and tenderness to palpation (TTP) over the anterior aspect of the left hip flexor. The examiner diagnosed unresolved left hip flexor strain. The MEB n arrative s ummary (NARSUM) exam documented that the CI was unable to return to training due to hip pain. The examiner noted that the CI could not perform his duties due to his inability to stand for prolonged periods or carry heavy weights. The examiner opined that the CI was compliant with his treatment and that his prognosis for further recovery as a ci vilian was excellent. The physical exam findings were mild antalgic gait, full active range - of - motion (ROM) of the hip, strength was normal ; however , there was TTP over the hip flexors and pain with flexion over the anterior flexor area. The examiner noted that the CI’s pain rating was minimal and frequent. The c ommander’s s tatement noted that the CI had been diagnosed with a stress fracture, which limited his participation in any further training . The p rimary c are examiner noted unresolved left hip pain with physical exam findings of mild antalgic gait, 90% squat with minor pain, TTP over the le f t inguinal ligament and proximal hip flexors. The examiner diagnosed left hip flexor tendonitis. The o rthopedist noted a significant increase in the CI’s left hip pain with increased pain on weight bearing and with running. The examiner diagnosed rule out femoral neck stress fracture and ordered more X -rays and a strict profile. The o rthopedist 3 days later no t ed that the bone scan was normal; however the CI still reported that his pain had worsened . The orthopedists then recommended that the MEB process be continued. There was no VA Compensation and Pension exam completed.

The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the l eft h ip p ain s / p i njury condition as 5022 (p eriostitis ) and rated at 0%. The VA coded the s / p f lexor s train; l eft hip condition as 5 3 99 analogous to 5314 ( Group XIV Function ) and rated at 10% consistent with “m oderate . The VA based their rating on the evidence from the STR. All exams accomplished proximate to separation documented painful motion with activities. The NARSUM examination and STRs warrant application of VASRD §4.59 (painful motion) and §4.40 (functional loss) to achieve the minimal compensable rating (10%). There is no compensable ROM impairment under either the 5251 (limitation of extension) or 5252 (limitation of flexion) codes. The Board considered c ode 5253 (thigh, impairment); but, loss of motion beyond 10 degrees abduction was not documented and this was the only route to a rating higher than 10% under that code. The Board co n sid ered using codes 5399 -5314 ; however , members agreed that code 5022 more aptly described the condition. Thus , there is no route to a rating higher than 10% under any applicable joint code and no coexistent pathology, which would merit additional rating for the hip condition under a separate code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% 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 l eft h ip s / p i njury condition, the Board unanimously recommends a disability rating of 10 %, coded 5099- 5022 IAW VASRD §4.71a. 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 his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Left Hip Pain s / p Injury 5099- 5022 1 0%
COMBINED 1 0%
invalid font number 31502

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20 041225 , w/atchs
Exhib
it B. Service Treatment Record
Exhibit C. Department of Veterans
Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review



SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for
XXXXXXXXXXXXXXX , AR20150007434 (PD201301756)


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 10% 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                                                 
XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01224

    Original file (PD-2013-01224.rtf) Auto-classification: Approved

    Bilateral Knee 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 knee pain condition, the Board unanimously recommends...

  • AF | PDBR | CY2012 | PD 2012 00953

    Original file (PD 2012 00953.rtf) Auto-classification: Approved

    The PEB adjudicated bilateral anterior knee pain syndrome as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy and recurrent stress fracture of right tibia as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD). The MEB examiner referred to the exam results documented on the MEB DD Form 2808 which are summarized in the chart above.The VA Compensation and Pension (C&P) exam approximately 8 days prior...

  • AF | PDBR | CY2014 | PD-2014-01674

    Original file (PD-2014-01674.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. A bilateral foot X-ray showed a healing left 2nd metatarsal stress fracture and a probable new stress fracture of the left 3rd metatarsal. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2013 | PD-2013-00176

    Original file (PD-2013-00176.rtf) Auto-classification: Denied

    Service IPEB – Dated 20021122VA - Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Recurrent Medial Tibial Stress Syndrome (Shin Splints)5022-500310%Recurrent Bilateral Medial Tibial Stress Syndrome5022-52620%*Service Treatment Record(STR)Chronic Shin SplintsCategory IIGERDCategory IIIDuodenal Ulcer Disease73050%STRRecurrent UrolithiasisCategory IIIUrolithiasis75080%STRNo Additional MEB/PEB EntriesOther x 1STR Combined: 10%Combined: 0%Derived from VA Rating Decision...

  • AF | PDBR | CY2013 | PD-2013-01204

    Original file (PD-2013-01204.rtf) Auto-classification: Denied

    The record contains well documented evidence of significant left thigh muscle injury with an open, comminuted femur fracture that required ORIF and subsequent bone grafting. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: DoD Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-02762

    Original file (PD-2013-02762.rtf) Auto-classification: Denied

    These were considered together as right and left lower leg conditions for determination of fitness. The Board agreed the left hip condition was mild.The records noted periods of both hip pain and no hip pain.Routine X-rays, bone scans of the hips revealed no pathology. The Board noted the report of the CI at the time of the NARSUM thatleft hip pain “radiated from the back.”After due deliberation, considering all of the evidence, the Board agreed that there was no preponderance of evidence...

  • AF | PDBR | CY2014 | PD-2014-01747

    Original file (PD-2014-01747.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Chronic Pain, Left Foot Condition . RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2014 | PD-2014-01684

    Original file (PD-2014-01684.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Pain Left Leg5099-500310%Periostitis with Left Leg Traction (claimed as shin splints and left leg pain)50220%20040831Left Knee Strain5024-526110%Left Foot S/P Third Metatarsal Stress Fracture5299-52830%Other x0Other x 0 Rating: 10%Combined: 10%Derived from VA Rating Decision (VARD) dated 20050314 (most proximate to date of separation [DOS]) ANALYSIS SUMMARY : Chronic Pain Left Leg Condition . Six months prior to separation,...

  • AF | PDBR | CY2014 | PD 2014 00677

    Original file (PD 2014 00677.rtf) Auto-classification: Denied

    Separation Date: 20071031 The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The CI was given a temporary U3 profile for left shoulder pain; however, there were no associated limited duties.The CI underwent a diagnostic arthroscopy with debridement of the shoulder labrum on 24 January 2007.Throughout 2007, the CI was treated by PT for chronic left...

  • AF | PDBR | CY2014 | PD-2014-01154

    Original file (PD-2014-01154.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Examination noted normal lumbar spine ROM with pain and normal bilateral hip ROM.An orthopedic evaluation on 27 March 2009, 5 months prior to separation, noted a 16-month history of pelvic pain following pregnancy. At...