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AF | PDBR | CY2013 | PD-2013-02319
Original file (PD-2013-02319.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXX       CASE: PD-2013-02319
BRANCH OF SERVICE: Army  BOARD DATE: 20140916
SEPARATION DATE: 20050709


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A10/Automated Logistics Specialist) medically separated for chronic right hip pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded “chronic right hip pain secondary to right hip femoral acetabular impingement, not responsive to surgery” to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions, all meeting retention standards. The Informal PEB adjudicated the CI’s chronic right hip pain as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting and not ratable. The CI appealed to the Formal PEB (FPEB) but then withdrew her appeal and accepted the IPEB findings. The CI was then medically separated.


CI CONTENTION: “1. Left hip due to right hip 2. Left knee due to right hip 3. Lower back”


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 chronic right hip condition is addressed below. Neither the MEB nor the PEB documented the left hip, the left knee or the lower back conditions for disability evaluation and therefore these contended conditions are not within the Board’s scope of review. 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 Army Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20050321
 VA - (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Hip Pain 5099-5003 10% S/P ORIF, Right Hip 5252 10% 20050819
Other x 0 (Not in Scope)
 Other x 8 20050822
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 60208 (most proximate to date of separation )
VARD 20090501 changed DC 5252 to 5252-5253 and increased the rating to 20% effective 20081118. VARD 20090707 increased DC 5252-5253 to 100%, post operatively; effective 20081106 then decreased the rating to 20% effective 20090301. VARD 20090818 increased DC 5252-5253 to 30% effective 20090301.


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the impairment with which her service-connected condition continues to burden her, but, must emphasize that the military 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.

Chronic Right Hip Condition. The service treatment record indicated the CI noted pain in the right hip when she stepped into a shower and heard a pop on 3 December 2003. She was treated with activity modification without improvement. An orthopedic evaluation, almost 2 months after the initial injury, noted pain with provocative maneuvers consistent with tear of the cartilage of the hip joint. Range-of-motion (ROM) measurements indicated forward flexion of 110 degrees (normal 125 degrees) and abduction of 45 degrees (normal 45 degrees). A bone scan demonstrated stress changes of the hip. Magnetic resonance imaging (MRI) and computer tomography (CT) scans demonstrated a subchondral (below the cartilage) acetabulum (hip socket) cyst. X-ray images of the pelvis revealed evidence of femoral-acetabular impingement. She underwent a right hip femoral neck surgery on 13 April 2004. Post-operatively, she had nonunion at the surgical site. A MRI of the right hip in October 2004 showed that the bone was viable (with a good blood supply) and subsequently, she underwent an open reduction and internal fixation with bone grafting to repair the nonunion a mother later, in November 2004. However, the CI hip pain remained constant following surgery and she was not able to return to full duty.

A permanent L3 profile was issued on 14 December 2004 for right hip fracture (right knee pain P2 injury) which precluded the CI from most military activities. At the MEB examination performed on 17 December 2004, the CI reported a “plate and cables in the right hip.” The MEB physical examiner noted decreased ROM with no abduction, 80 degrees flexion, no extension and 30 degrees external rotation. The commander’s statement dated 11 January 2005 related significant duty limitations from the hip.

The MEB narrative summary (NARSUM) was based upon an examination dated 25 January 2005. The CI complained of pain at the extremes of abduction (outward motion). The examiner indicated the CI’s operative site was well-healed, but the right hip was tender to palpation over the lateral aspect of the joint and she walked with an abnormal gait. However, the strength in all of her muscle distributions was reported to be normal. An X-ray image of the right hip in January 2005 revealed union at the surgical site. The ROM was limited as charted below. Physical therapy did not alleviate her symptoms. Any activity involving the right hip caused pain, which was exacerbated by increasing physical activity.

At the VA Compensation and Pension (C&P) examination dated 22 August 2005 (performed 2 months after separation), the CI reported her hip condition was caused by physical training. She complained of hip pain without swelling or redness and noted that during a flare-up, there was a sharp, shooting pain that radiated down into the back of her right knee and up into the buttock. She was able to complete all activities of daily living, but had some pain in the lower body with activity that required use of the hip muscles. Although the CI was noted to be overweight, no comment was made regarding restriction of ROM due to body habitus and the left hip ROM was near normal. The ROMs in evidence, which the Board weighed in arriving at its rating recommendation, along with documentation of additional ratable criteria, are summarized in the chart below.
Right Hip (Thigh) ROM
(Degrees)		 MEB ~6 Mo. Pre-Sep VA C&P ~2 Mo. Post-Sep
Flexion (125 Normal) 95 90 (Pain began at 70)
Extension (20) 15 Not measured
External Rotation (45) 30 Not measured
Abduction (0-45) 30 30 (Pain throughout)
Adduction (45) 30 30 (Pain throughout)
Comment Abnormal gait with pain on the extremes of abduction. Painful throughout range-of motion
§4.71a Rating 10% PEB 10%
invalid font number 31502

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both assigned a 10% rating using the code 5099-5003 (degenerative arthritis) and coded 5252 (thigh, limitation of flexion) respectively. The Board was unable to find a route to a higher rating; there was a good union after surgery and the ROM in all planes supports no more than a 10% rating. 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 for the right hip 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 Right 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 re-characterization of the CI’s disability and separation determination.


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








                          
                           XXXXXXXXXXXX
                           President
                           Physical Disability Board of Review

 invalid font number 31502 SAMR-RB                                                                         


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


 invalid font number 31502 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXX, AR20150005545 (PD201302319)
 invalid font number 31502

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                                                  XXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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