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AF | PDBR | CY2013 | PD-2013-01832
Original file (PD-2013-01832.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-01832
BRANCH OF SERVICE: Army  BOARD DATE: 20140605
SEPARATION DATE: 20050119


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (92F10/Supply Specialist) medically separated for left hip pain. The condition could not be adequately rehabilitated to meet the physical requirements of basic training 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 “left hip pain status-post displaced femoral neck fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB forwarded no other conditions. The Informal PEB adjudicated “left hip pain with a history of a femoral neck fracture” as unfitting, rated 0%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “I broke my hip while I was in Basic Training. I was unable to continue my service. While I was still in the military I discovered I had thyroid cancer – the start of it in Jan 2005. I was discharged from the Army w/ a 0% rating & was advised to go through the VA for the disability rating. This should be reviewed as this happened while serving in the Army. I have enough medical records to support this.”


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 determined to be not unfitting by the PEB, when specifically requested by the CI. The rating for the unfitting left hip condition is addressed below; no other conditions are within the DoDI 6040.44 defined purview of the Board. The thyroid cancer condition was not identified by the PEB and was not diagnosed until after separation from service; thus, is not 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 20041129
 VA - (5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Hip Pain 5099 5003 0% Residuals, Fracture of Femoral Neck, Left Hip 5255 10%* 20050602
No Additional MEB/PEB Entries
 Other x 1 20050602
Rated: 0%
 Combined: 10%
* Derived from Decision Review Officer Rating Decision dated 20060418 effective retroactive to date of separation ( DOS ) based on de Novo review of existing evidence .
Original VA Rating Decision dated 20050722(closest to DOS) granted a 0% rating.





ANALYSIS SUMMARY:

Left Hip Condition. During basic training the CI had a bone scan positive diagnosis of a left hip stress fracture that eventually became a frank femoral neck (hip area) fracture after she fell during range training in September 2004. Initial treatment was a closed reduction and pinning of the hip with eventual multiple screw placement/reduction of the left hip in December 2004. Despite aggressive physical therapy coupled with non-weight bearing, her pain symptoms persisted with any ambulation for the remainder of her career. Post-service orthopedic follow-up examination noted probable painful screws in the left hip and recommended removal of hardware at a minimum of one-year post insertion. The narrative summary (10 weeks pre-separation) recorded hip range-of-motion (ROM) as 110 degrees flexion (normal 125 degrees) and 20 degrees extension (normal 30 degrees). The MEB examiner documented the presence of pain as the limiting factor for ROM extremes. The VA Compensation and Pension general examination (4 months post-separation) recorded full, but painful motion. Neither these measurements nor those recorded for abduction, adduction, internal rotation or external rotation achieved the minimal compensable thresholds for any of the hip joint codes in the VA Schedule for Rating Disabilities (VASRD). There was no atrophy or muscle abnormality present. The VA examiner documented the presence of pain as the limiting factor for ROM extremes.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the hip, although both initially arrived at the same 0% rating. The PEB coded analogous to degenerative arthritis and the VA rated 0% citing the absence of hip disability without femur malunion. The PEB’s 0% rating analogous to 5003 (degenerative arthritis) rested on application of the USAPDA pain policy which circumvents VASRD §4.59 (painful motion) and both the service and VA examination clearly documented pain-limited motion. The VA subsequently noted this in a De Novo review by a Decision Review Officer pursuant to the CI’s disagreement with her VA rating; the VA raised the rating to 10% for painful motion retroactive to the CI’s date of separation. Absent persistent fracture without nonunion or malunion and the presence of hip disability greater than “slight,” there is no route to an impairment rating higher than 10% (§4.59) under any applicable code and no coexistent pathology which would merit additional rating for the hip condition under any other 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.


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 the left hip was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left hip condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59. There were no other conditions within the Board’s scope of review.


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
Left Hip Pain 5099 5003 10%
RATED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131021, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                 
XXXXXXXXXXXXXXXXXX
President
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, AR20150001225 (PD201301832)
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

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