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AF | PDBR | CY2013 | PD2013 02017
Original file (PD2013 02017.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1302017
BRANCH OF SERVICE: Army  BOARD DATE: 20140620
SEPARATION DATE: 20040409


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31C/Signal Corps) medically separated for a right hip condition. The right hip condition did not improve adequately to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB). The right hip condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB found the right hip condition unfitting, and rated it 0%. The CI made no appeals and was medically separated.


CI CONTENTION: “I have received a Total Rating of 80% from The Department of Veterans since my Discharge from the Army. I believe that my rating should have been higher due to the damage to my hip and my lower back. I have a Claim outstanding for my ankles and my knees and I also have an Appeal Outstanding since Aug 2007 when I signed and mailed the documents to my Regional Office”


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 other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Army PEB – dated 20030120
 VA – (6 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Hip Pain 5099-5003 0% Residuals, Right Hip Fracture 5255 10% 20041029
No other MEB/PEB Entries
 Other x 3
Combined: 0%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20070327


ANALYSIS SUMMARY: It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates. While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career and then only to the degree of severity present at the time of separation. The VA however, is empowered to compensate for all service-connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the disability rating should the degree of impairment change over time.

Right Hip Condition. This CI fell and was injured during basic training. After that fall, she had right hip pain. Imaging studies showed a fracture of the pubic rami. She was treated with rest, medications, and physical therapy. However, the pain persisted and an MEB was initiated. The MEB narrative summary was dictated in September 2003. Physical examination (PE) of the right hip revealed pain at extreme ranges of motion. Neurovascular status was intact. Right hip range-of-motion (ROM) was measured, and is summarized in the chart below. The CI was separated from service on 9 April 2004. Six months later, she had a VA Compensation and Pension exam. At that time, she was non-ambulatory due to recent foot surgery. PE of the right hip showed some questionable tenderness in the trochanteric area. The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Hip ROM
(Degrees)
 MEB ~ 6½ mos . Pre-Sep
 (20030923) 		VA C&P ~ 6½ mos . Post-Sep
 (20041029)
Flexion (125 Normal)
 110 90
Extension (20)
 (not recorded) “full y ”
External Rotation (45)
 40 (not recorded)
Abduction ( 45)
 40 45
Adduction (45)
 (not recorded) 15
Comment
 Painful motion Painful motion
§4.71a Rating
 10 % * 10 % *
*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) invalid font number 31502

The Board carefully examined all available evidence and directs attention to its rating recommendation. The Army PEB and the VA chose different coding and rating options for the right hip condition. The Board considered the results of the two ROM examinations shown above. At both exams, the CI had 90 (or greater) degrees of right hip flexion and 40 (or greater) degrees of right hip abduction. After a thorough review of the treatment record, the Board determined that the right hip condition was essentially non-compensable based solely on the VASRD §4.71a codes for the hip and thigh (5250 through 5255). However; IAW VASRD §4.40, §4.45, and §4.59, a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled. A rating of 10% is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. After reviewing the evidence, all Board members agreed that a rating of 10% was appropriate for the right hip condition. The Board tried to find a path to a higher rating, using other codes which could be applied to the hip condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling hip condition which would justify a higher rating. 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 unfitting right hip condition. It is appropriately coded 5299-5255 and IAW VASRD §4.40, §4.45, and §4.59, meets criteria for a 10% rating due to painful motion of a major joint.


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. Army PEB reliance on the USAPDA pain policy may have been operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the unfitting right hip condition and IAW VASRD §4.40, §4.45, and §4.59; the Board unanimously recommends a rating of 10%. There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION: The Board, therefore, 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
Right hip pain, due to non-healing fracture of pubic rami 5299-5255 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131025, 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 XXXXXXXXXXXXXXXXXX , AR20140019497 (PD201302017)
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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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