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AF | PDBR | CY2014 | PD-2014-00544
Original file (PD-2014-00544.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-00544
BRANCH OF SERVICE: Army  BOARD DATE: 20150527
SEPARATION DATE: 20040909


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve O-3 (Transportation Officer) medically separated for left groin and hip pain. The left groin and hip pain condition could not be adequately rehabilitated to meet the physical requirements of his Area of Concentration. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “severe osteoarthritis left hip,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other medically acceptable conditions (pes planus; hypertension, controlled and; hyperlipidemia) for PEB adjudication. The Informal PEB (IPEB) adjudicated the left groin and hip pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: “I served a total of23 years in the Active and Reserve Components from the September 1981 to September 2014. According to "The Wounded Warrior Act" signed into law on January 28, 2008. (1) I served during the periods of September 11, 2001 and December 31, 2009 and (2) "found unfit for continued military service by a PEBR with a disability rating of zero and (3) based on that determination and I was found not eligible for retirement" at that time. I should have received\par granted a PDBR rating of 30% or higher for my injury/illness along with a medical retirement. I served my country honorably in several capacities from Aviation MOS as an Enlisted soldier (PFC) up to the Officer ranks as a CPT in Field Artillery I Transportation Branch. I also served in extremes environments from the Desert to the Frozen Tundra of Alaska. A Memo to Walter Reed Army Medical Center, Washington, DC Dated 14 June 2004; Subject: Commander's Performance Statement to Walter Reed Army Medical Center, first paragraph was grossly incorrect and may have added an additional injustice in that it stated "I suffer from Osteoarthritis and Chronic left hip pain prior to deployment". It should have stated "I Did Not suffer from Osteoarthritis and Chronic Left Hip pain prior to deployment" it occurred and was diagnosis while I was serving on active duty during the period stated above in block 3. My right hip was also diagnosis as record will show at the same time as my left hip was being evaluation and should have been consider in the board evaluation due to the fact the injury occurred in Alaska while on Active duty. I strongly believed that my Medical Evaluation Board Proceeding should have also included in Block 13 (a), a diagnosis which reveal that I have a Sinus bradycardia with 1st degree AV. I listed in Item 3 and Item 13 along with supporting documents to grant a PDBR rating of 30% or higher and based on that determination, I should be granted a medical retirement warrant of my service, commitment and dedication to the U.S. Army and United States of America.”


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 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 20040729
 VA* - (~10 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Groin and Hip Pain 5003 0% Degenerative Joint Disease of the Left Hip (Claimed as Left Hip Injury) 5003 10% 20050628
Other x 0 (Not In Scope)
 Other x 17
RATING: 0%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 50713 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Left Hip Condition. The service treatment record documents onset of left hip symptoms in 2002. The 8 April 2003 imaging studies showed significant left hip degenerative joint disease by pelvis X-ray, and severe left hip osteoarthritis with probable avascular necrosis (bone tissue death due to lack of blood supply) by magnetic resonance imaging (MRI). The 17 February 2004 orthopedic surgery MEB consultation documented the CI “complains about left hip and groin pain for approximately one year. He denies trauma. … The patient is unable to run, jump or ruck march secondary to this pain. The patient is able to walk for a maximum of 2-miles secondary to this pain.” The physical exam showed the CI had equal leg length and was neurovascularly intact. The pain limited range-of-motion (ROM) values are listed in the chart. The assessment listed left hip pain secondary to severe osteoarthritis. The examiner opined there were no surgical indications at that time but the CI may be a candidate for total hip replacement in the future. The narrative summary (NARSUM) 4 months prior to separation, the CI reported symptom onset in the fall of 2002, which “felt like a pulled muscle” in the medial groin. It documented “The patient states that he has pain in his left hip, which is currently intermittent, and he rates it at an 8/10. His symptoms are precipitated by walking in boots, prolonged standing, or walking, climbing stairs, and weather changes.” His symptoms were somewhat alleviated by medication (Tylenol), heat, and resting partially supine. The NARSUM cited the ROMs from the orthopedic consultation. The physical exam documented “He has limited range of motion of the left hip especially flexion and external rotation. He has pain with squat and duck walk. Heel and toe walk were normal. There was no tenderness to palpation over the hip. The remainder of his physical was normal.” The 4 June 2004 physical therapy (PT) left hip ROM measurements for the MEB are listed in the chart. The 29 June 2005 lumbar spine and left hip X-rays showed degenerative changes of the left hip and possible avascular necrosis. The Compensation and Pension (C&P) 10 months after separation exam, the CI reported he injured his left hip during a ruck march in 2002. He complained of left hip pain with associated stiffness, heat, and daily flare-ups. He denied dislocations or incapacitation. The CI reported he lost 10 days of work in the past year due to his hip. Physical exam revealed a normal posture, normal gait, and no unusual shoe wear pattern. Left hip exam revealed tenderness over the greater trochanter. There was no edema, effusion, weakness, redness, heat, instability, abnormal movement, or guarding of movement. There was normal strength, sensation, and deep tendon reflexes. There was no objective evidence of painful motion, but the CI endorsed pain at the extremes of ROM, and reported had too much pain to do repetitive movement. The left hip ROMs are listed in the chart.

The ROM evaluations which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Hip (Thigh) ROM
(Degrees)		 MEB 4 Mo. Pre-Sep
PT 3 Mo. Pre-Sep
VA C&P 10 Mo. Post-Sep
Flexion (125 Normal) 90 95 55
Extension (20) -- 5 20
External Rotation (45) 25 30 20
Abduction (0-45) 30 20 30
Adduction (45) -- 10 25
§4.71a Rating 0 % 10 % 0 %

The Board directed attention to its rating recommendation based on the above evidence. A month prior to separation the IPEB rated the left hip condition 0% (VA code 5003; degenerative arthritis). The PEB cited left groin and hip pain, MRI findings, and ROM. The VARD 10 months after separation rated the left hip condition 10% (5003). The VARD cited painful or limited motion of a major joint, functional loss due to pain, pain with ROM, and degenerative changes on imaging. A 10% rating was justified under 5251 (thigh, limitation of extension of) based upon the 3 months prior to separation PT ROM exam, but not the 10 months afterseparation VA C&P exam. There was no compensable limitation of motion for consideration under 5252 (thigh, limitation of flexion of). There was no evidence of disability for consideration of rating under 5250 (hip, ankylosis of), 5253 (thigh impairment of abduction, adduction, rotation of), 5254 (hip, flail joint), or 5255 (femur fracture nonunion/malunion of). Board members agreed a 10% rating was justified IAW §4.40 (functional loss) and §4.59 (painful motion). 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 (5003).


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, the Board unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Left Hip Condition 5003 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140122, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXXXX, AR20150014217 (PD201400544)
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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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