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AF | PDBR | CY2013 | PD-2013-02355
Original file (PD-2013-02355.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02355
BRANCH OF SERVICE: Army  BOARD DATE: 20141121
SEPARATION DATE: 20050322


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was an active duty PFC/E-3 (97E/Human Intelligence Collector) medically separated for right hip pain. The hip condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards, so he was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The hip condition, characterized as “Status post closed reduction of right hip fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic right hip pain” as unfitting, rated at 10%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “After separation VA diagnosed me. Seeing private counselor for approx.. three years (CI included counselor contact information).”


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 right hip condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. The contended posttraumatic stress disorder was not identified by the PEB and is therefore not in the purview of this 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. IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20050311
 VA - (# Mos. Pre/Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Hip Pain, S/P Operative Fixation… 5099-5003 10% S/P Right Hip Fracture 5252 10% 20050316
Scar, Right Hip 7805 0%
No Additional MEB/PEB Entries in Scope
Combined: 10%
 Combined: 10%


ANALYSIS SUMMARY:

Right Hip Condition. The narrative summary (NARSUM) notes the CI to have sustained a stress fracture of the right upper hip bone (Femoral neck) in June 2004. A surgical repair was performed in August 2004 with placement of three surgical screws. Post-operatively the CI developed painful motion in the hip area. On an orthopedic evaluation on 19 October 2004, the CI reported some pain with walking. The hip surgical site was well healed and range-of-motion (ROM) of the hip was “full” without pain. At the MEB NARSUM evaluation on 10 February 2005, a month prior to separation, the CI reported continued hip pain with ambulation. The MEB physical exam noted the CI to walk with a slight limp. Pertinent findings on physical exam are reported in the chart below. Routine X-ray images of the hip revealed healing with no evidence of loosening or displacement of the surgical screws.

During the VA Compensation and Pension exam performed 6 days prior to separation, the CI reported constant dull aching pain in the hip area. Gait was described as normal. The pertinent findings on examination of the hip are reported in the chart below. The surgical scar was noted to be well healed without tenderness, ulceration, or instability and having impact on hip motion. A routine X-ray of the Hip revealed “complete” healing. The goniometric active ROM evaluations in evidence the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Righ t Hip (Thigh) A ROM
(Degrees)		 Ortho ~ 5 Mo. Pre-Sep
(20041019)
 MEB ~1 Mo. Pre-Sep
(20050210)
 VA C&P 6 Days Pre-Sep
(2005031 6 )
Flexion (125 Normal) “ FULL ” 120 100
Extension (20) “ FULL ” 30 22
External Rotation (45) “ FULL ” 45 54
Abduction (0-45) “ FULL ” 45 40
Adduction (45) “ FUL L ” 25 18 (VA cites 25 as normal )
Comment No pain on motion No pain on motion; motor/sensory intact; no crepitus Motor/sensory intact ; No DeLuca

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the hip condition IAW the USAPDA pain policy at 10%. VA rated the hip condition 10%, code 5252 (thigh, limitation of flexion). A 10% rating under this code requires hip flexion limited to 45 degrees. The Board adjudged that the record sufficiently documented pain on motion to meet the requirement for 10% rating IAW §4.59. The Board agreed that no compensable rating could be recommended under ROM criteria, codes 5251, 5252 and 5253. The Board agreed that no rating higher than 10% could be recommended under code 5255, (femur impairment). A 20% rating under code requires the hip condition to be “moderate” not supported by the record in evidence. The Board considered a rating under code 7804, (scars) but was unable to do so as the surgical scar was well healed without, tenderness, instability or functional impact. The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10% for the hip condition. 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 chronic right 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 DoDI 1332.39 for rating the hip was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right hip 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 no re-characterization of the disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131102, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXX
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 XXXXXXXXXXXXXX, AR20150006482 (PD201302355)

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

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