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AF | PDBR | CY2013 | PD-2013-02815
Original file (PD-2013-02815.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02815
BRANCH OF SERVICE: AIR FORCE    BOARD DATE: 20150428
SEPARATION DATE: 20061213


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Basic Airman) medically separated for a left hip condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty. She was referred for a Medical Evaluation Board (MEB). The “left greater trochanteric bursitis,” and “stress changes bilateral ankles and knees,” noted as existing prior to service (EPTS), and “possible mild left gluteal tendinopathy (likely related to previous injection),” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “left hip pain associated with greater trochanteric bursitis, mild left gluteal tendinopathy (likely related to previous injection). Aggravated by military service” as unfitting, rated 10%. The remaining condition was determined to be C ategory II , EPTS and not c ompensable . The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her application.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. 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 Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

IPEB – Dated 20061207
 VA* - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Left Hip Pain… 5019-5003 10% Snapping Hip Syndrome, Left 5299-5252 NSC STR
Other x 1 (Not In Scope)
 Other x 3 (NSC)
RATING: 10%
 RATING: NSC
* Derived from VA Rating Decision (VA RD ) dated 200 81030 (most proximate to date of separation [ DOS ] ) .



ANALYSIS SUMMARY:

Left Hip Pain Associated with Greater Trochanteric Bursitis, Mild Left Gluteal Tendionopathy (Left Hip) Condition. The narrative summary noted onset of left hip pain during basic training after falling out of bed. Imaging documented no fractures or ligament tears, but minor hip joint abnormalities (retroversion of the acetabulum; mild irregularity of the anterior-superior labrum; and femoral neck bone lesion compatible with fibrous dysplasia). There was no evidence of degenerative changes or ligament or cartilage tears. Orthopedic evaluation diagnosed left snapping hip syndrome and left trochanteric bursitis (inflammation of the hip joint) and the CI had a steroid injection into the left hip with “nearly complete resolution of her symptoms.” The CI had additional hip imaging (MR arthrogram) that supported fibrous dysplasia with no evidence of significant degenerative changes at the left hip or left acetabular labral tear and a new finding of mild inflammation of the gluteal tendon at the hip. Repeated orthopedist assessment diagnosed a left hip snapping psoas tendon and a possible mild left gluteal tendinopathy likely related to the previous injection. Continued physical therapy and non-steroidal medications were recommended and surgery was not indicated.

At the MEB exam, the CI reported continued left hip pain. Exam documented “no pain with range of motion in either direction of her hip” with focal tenderness of the hip (over the greater trochanter) with pain with loading (resisted/pressured motion) and internal rotation of the hip. There was palpable snapping and palpating the hip recreated the CI’s hip pain. A goniometric range-of-motion evaluation performed by physical therapy on 6 December 2006, a week prior to separation, documented left hip flexion of 120 degrees (normal 125) with slightly limited extension (10 of 20 degrees), external rotation (25 of 45 degrees) abduction (20 of 45 degrees) and adduction (35 of 45 degrees). There were no other exam details on that physical therapy exam.

There was no VA Compensation and Pension (C&P) exam performed proximate to separation, and the above VA “rating” was based on the service treatment exam. The first VA C&P was performed in October 2011, nearly 5 years after separation, documented pain-limited motion and led to a VA 10% hip rating effective in August 2010.

The Board directed attention to its rating recommendation based on the above evidence. There were treatment notes that supported painful motion of the hip warranting a 10% rating IAW VASRD §4.59. Coding analogous to 5019 (Bursitis) was appropriate and alternate coding under 5020 (Synovitis) or 5024 (Tenosynovitis) would apply the same criteria and offer no benefit. There was insufficient evidence of arthritis, hip flexion limited to 30 degrees or less, abduction lost beyond 10 degrees, or fracture or ankylosis (frozen joint) to warrant any rating higher than 10% under any other disability coding (codes 5250-5255 for the hip and thigh). 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’s 10% rating of the 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 left 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 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 20131219 w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

invalid font number 31506

SAF/MRB

 1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXX

Dear XXXXXXX:

 Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02815 .
         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

 Sincerely,





XXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
 SAF/MRBR

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