Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02708
Original file (PD-2013-02708.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02708    
BRANCH OF SERVICE: MARINE CORPS          BOARD DATE: 20140724
SEPARATION DATE: 20040930       


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (0341/Mortarman) medically separated for bilateral hip degenerative joint disease (DJD). The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). The bilateral hip DJD condition characterized as “medically unacceptable” and was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded two other left hip conditions. The Informal PEB adjudicated “bilateral hip DJD” as unfitting, rated at 10%. The remaining two conditions of h istory of slipped capital femoral epiphysis with left hip pinning and s tatus post (S/P) left hip surgical dislocation and osteotomy , were determined to be Category II. The CI made no appeals and was medically separated.


CI CONTENTION: “the issues of Bilateral Hip DJD, S/P Left Hip surgical Dislocation and Osteotomy and History of Slipped Capital Femoral Epiphysis with Hip pinning, I am having continued problems and surgeries for the above named disabilies.”


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 ratings for the unfitting bilateral hip DJD condition is addressed below; as well as the Category II conditions related to the left hip and there were no additional conditions 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 20040709
 VA - (5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Hip DJD 5003 10% Slipped Capital Femoral Epiphysis Left Hip 5252 10% 20050210
History of Slipped Capital Femoral Epiphysis with Left Hip Pinning Cat II
Status Post Left Hip Surgical Dislocation and Osteotomy Cat II
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 50414 ( most proximate to date of separation )




ANALYSIS SUMMARY:

Bilateral Hip DJD Condition. The narrative summary (NARSUM) noted bilateral hip pain (left greater than right). The CI had undergone left hip pinning at age 14 for slipped capital femoral epiphysis (SCFE) which resulted in having daily bilateral hip pain (the record contained the pre-service operative reports and a MEPS consult favorable for service entry, but the MEPS physical/waiver was absent). Hip pain had increased since 2002 and the CI had trauma from a hard landing (civilian parachuting) in March 2003 with immediate left hip pain causing weight bearing limitations. Evaluation demonstrated left hip bony abnormalities (osteophyte and rim lesions) with radiographs summarized as demonstrating anterior wall fracture of bilateral hips. Range-of-motion (ROM) of both hips were the same with forward flexion of 90⁰ (normal 125⁰) and hip pain worsened with flexion.

The CI underwent surgical repair of his left hip in June 2003 with good results and return to duty in December 2003. With activity, the CI had increased of pain in his left hip March 2004 which led to MEB referral. Evaluation documented stable hip repair and good position. The MEB physical exam documented left hip decreased ROM (limits not specified), 4/5 hip flexion (strength), and normal gait [there was no specific evaluation comment of the right hip]. A more detailed ROM performed by an orthopedic surgeon dated 19 March 2004 had documented left hip painful with motion, a forward flexion of 110 degrees (normal 125 degrees) and abduction to 25 degrees (normal 45 degrees) [the right hip was not evaluated at that visit]. His gait was normal.

At the VA Compensation and Pension (C&P) exam (performed 5 months after separation), the CI reported left hip pain with worsening after his in-service second surgery. Pain was a constant 6/10 with flares to 8/10 with radiation. Exam documented a slow, but normal gait. ROM was noted as with discomfort with forward flexion of 90 degrees (normal 125 degrees), abduction of 34 degrees (normal 45 degrees) and normal internal and external rotation. Radiographs documented two screws in place and small calcified bodies and soft tissues of uncertain significance. VA records (over eight years after separation) indicated that the CI had increased right hip symptoms with a 10% rating effective in March 2013 and other hip disability codes were also added at 0%. The CI underwent a left total hip replacement in June 2013 with a temporary VA 100% rating and then a 30% rating effective July 2014.

The Board directs attention to its rating recommendation based on the above evidence. The PEB noted that the bilateral hip condition was EPTS (existed prior to service), but that the reduction was 0% with a combined bilateral hip rating of 10% coded 5003 (degenerative arthritis). The VA rated only the left hip at 10% coded 5252 (limitation of thigh flexion) and did not take any EPTS deduction. There was no VA rating for the right hip proximate to separation. All of the CI’s MEB diagnoses impacted the hips and are considered in rating of the hips.

The PEB combined the left and right hip conditions under a single disability rating, coded under 5003. Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints. The Board must follow suit (IAW DoDI 6040.44) if the PEB combined adjudication is not compliant with the latter stipulation, provided that each unbundled condition can be reasonably justified as separately unfitting in order to remain eligible for rating. If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.

The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. The left hip had in-service surgical intervention and was the predominate cause of clinic visits and duty limitations and was adjudged as reasonably unfitting by the Board. The CI had documented left hip pain limited motion warranting a 10% VASRD rating IAW VASRD §4.59 (painful motion). Post separation worsening was clearly documented, but proximate to separation there was no path to a higher rating (flexion was not limited to the 20% criteria of 30⁰ flexion).

There was extended Board deliberation if the right hip condition was reasonably unfitting and separately ratable. The right hip had documented pathology and pain-limited ROM noted in June 2003 (over a year prior to separation), but was not the focus of clinic visits. Considering all evidence, the right hip condition was adjudged by the Board majority as reasonably unfitting. The Board then considered if there was sufficient evidence for conceding painful motion of the right hip to warrant a 10% rating. The NASUM did not specify painful motion of both hips (only implied) and the only detailed right evaluation, even though remote from separation, documented painful motion. The Board majority adjudged that the right hip was unfitting and but the Board majority did not concede that there was sufficient reasonable doubt for an unfitting right hip with painful motion. Although the alternative adjudication of 10% for the left hip and 0% for the right hip was considered, it offered no benefit to the CI over the 10% (5003) rating assigned by the PEB. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hip condition. The single voter for dissent, did not elect to submit a minority opinion.


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 hip condition (including all MEB diagnoses) condition and IAW VASRD §4.71a, the Board majority 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131209, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXXX
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 26 Mar 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 USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01365

    Original file (PD-2013-01365.rtf) Auto-classification: Denied

    At retention physical dated 4 September 2002, the examiner documented a prior history of bilateral hip osteoarthritis, a 2001 right hip replacement, and noted “decreased ROM left hip” (no measurements were documented). Thus, the Board cannot recommend a separate service rating for this condition. In the matter of the osteoarthritis bilateral knees condition, the Board unanimously determined that neither knee was separately unfitting and that the condition EPTS and was not permanently...

  • AF | PDBR | CY2013 | PD-2013-01542

    Original file (PD-2013-01542.rtf) Auto-classification: Denied

    There was extremely limited service treatment record (STR)in evidence related to the low back pain condition for the Board to consider for rating recommendation. Bilateral Hip Pain .The PEB combined the bilateral hip pain conditions under a single disability rating analogously coded, 5003. As noted above, the Board,IAW VASRD §4.7 (higher of two evaluations), must consider separate ratings for PEB bilateral joint adjudications; although, separate fitness assessments must justify each...

  • AF | PDBR | CY2011 | PD2011-00424

    Original file (PD2011-00424.docx) Auto-classification: Approved

    Hip Condition . In the matter of the hip condition, the Board unanimously recommends permanent separation rating of 10% for each hip, coded 5299-5255 IAW VASRD §4.40, §4.45, §4.59, and §4.71a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

  • AF | PDBR | CY2012 | PD2012-01613

    Original file (PD2012-01613.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW BRANCH OF SERVICE: NAVY SEPARATION DATE: 20020708 NAME: X CASE NUMBER: PD1201613 BOARD DATE: 20130221 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Sailor IS2/E-5 (MOS/Intelligence Specialist) medically separated for bilateral hip pain with associated bilateral degenerative joint disease (DJD) of the hips and ununited fracture of the right greater...

  • AF | PDBR | CY2014 | PD-2014-02079

    Original file (PD-2014-02079.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. The examiner noted X-rays of both hips performed on 12 August 2009 were normal.At the VA Compensation and Pension (C&P) examination on 29 October 2009, 9 months after separation, there was full ROM of both hips with...

  • AF | PDBR | CY2013 | PD-2013-02717

    Original file (PD-2013-02717.rtf) Auto-classification: Denied

    DATE OF PLACEMENT ONTO TDRL: 20030523DATE OF REMOVAL FROM TDRL: 20070301 The “avascular necrosis of the bilateral femur heads, left greater than right” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.No other conditionwas submitted by the MEB.The Informal PEB adjudicated his bilateral hip conditions as unfitting, rated 20% left and 10% right, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). It then considered the right hip and left hip...

  • AF | PDBR | CY2009 | PD2009-00054

    Original file (PD2009-00054.docx) Auto-classification: Denied

    The medical basis for the separation was chronic low back pain (LBP) and multiple painful joints (Bilateral degenerative joint disease [DJD] of hips and knees as well as the left ankle) without any history of trauma. NARSUM (date 20020917): CHIEF COMPLAINT: This is a 26-year-old male with two-year history of bilateral shoulder pain, back pain, bilateral hip pain, bilateral knee pain left greater than right, and left ankle pain. The MEB diagnosis #1 (Medically Unacceptable) described...

  • AF | PDBR | CY2012 | PD2012-00635

    Original file (PD2012-00635.pdf) Auto-classification: Approved

    Groin Pain Condition. In the matter of the bilateral hip condition, the Board unanimously recommends that each joint be rated as separately unfitting at 10%, coded 5019, IAW VASRD §4.71a. Service Treatment Record Exhibit C. Department of Veterans Affairs Treatment Record XXXXXXXXXXXXXXXXXX President Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT:...

  • AF | PDBR | CY2012 | PD2012 01267

    Original file (PD2012 01267.rtf) Auto-classification: Denied

    She was medically separated for multiple stress reaction conditions.The CI reported an onset of foot pain 4 weeks into basic training in 2001, followed by pelvic and hip region pain that did not respond adequate to anti-inflammatory medication and physical therapy (PT)to meet the physical requirements of her MOS or satisfy physical fitness standards. The PEB combined the multiple lower extremities at 20% as noted above, and the VA adjudicated that the conditions were healed without sequelae...

  • AF | PDBR | CY2013 | PD-2013-01681

    Original file (PD-2013-01681.rtf) Auto-classification: Approved

    The neuropsychological report dated 12 April 2004, 3 months prior to separation, reported the CI had concentration and memory problems and mild headaches about twice a week. 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 condition only.Members agreed that based on the evidence, the right hip pain was not separately unfitting. In the matter of the left hip condition, the...