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AF | PDBR | CY2014 | PD-2014-02079
Original file (PD-2014-02079.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-02079
BRANCH OF SERVICE: Army  BOARD DATE: 20150212
SEPARATION DATE: 20090205


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-2 (Military Police) medically separated for chronic bilateral hip pain. The bilateral hip condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). “Chronic bilateral hip pain secondary to left femoral neck stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions (low back pain [LBP] and right shoulder pain) for PEB adjudication. The Informal PEB adjudicated “chronic bilateral hip pain secondary to left femoral stress fracture” as unfitting, rated 20%, c iting application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition s were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions”


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 :

Service IPEB – Dated 20081230
 VA* - (~9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Hip Pain Left; Stress Fracture 5299-5255 10% Left Femoral Neck Stress Fracture with Left Hip Pain 5255 10% 20091029
Chronic Hip Pain Right; Strain 5299-5255 10% Chronic Muscular Strain, Right Hip Associated with Left Femoral Neck Stress Fracture with Left Hip Pain 5099-5020 10% 20091029
Low Back Pain Not Unfitting Chronic Muscular Strain, Lower Back 5237 10% 20091029
Right Shoulder Pain Not Unfitting Chronic Rotator Cuff Impingement and Tendonitis, Right Shoulder 5299-5201 20% 20091029
Other x 0 (Not In Scope)
 Other x 0
COMBINED RATING: 20%
 COMBINED RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 20 100626 (most proximate to date of separation ( DOS ) ).


ANALYSIS SUMMARY:

Chronic Bilateral Hip Pain. According to the MEB narrative summary (NARSUM), the CI developed left hip pain during training. Magnetic resonance imaging (MRI) in July 2008 demonstrated a stress fracture of left hip femoral neck. She was treated with rest and physical therapy. Repeat MRI in September 2008 demonstrated improvement, but not complete healing. X-rays of the left hip 21 October 2008 were normal. At the time of the MEB NARSUM examination on 3 December 2008, the CI reported improvement in the left hip pain, however there was still pain with weight bearing activities. Following the onset of the left hip pain, the CI developed right hip pain. An MRI in September did not show any hip abnormalities and the CI was diagnosed with right hip strain due to compensating for the left hip. At the time of the MEB NARSUM examination, the CI reported that the right hip was more painful than the left. On examination there was mild tenderness in the hip region of both hips. Lower extremity strength was normal. The physical therapy range-of-motion (ROM) examination performed on 1 December 2008, reported bilateral hip active ROM after three repetitions. For the left hip (in degrees): flexion 115 (normal 125) with pain at 110; extension 15 without pain; abduction 45 without pain (normal 45); the left leg could cross over the right and externally rotate the toes out more than 15 degrees. For the right hip (in degrees): flexion 110 (normal 125) with pain at 100; extension 15 without pain; abduction 45 with pain at 35 (normal 45); the right leg could cross over the right and externally rotate the toes out more than 15 degrees. The CI was evaluated in a VA physical medicine clinic on 24 September 2009, for bilateral hip pain. Although the pain was improved since separation, it was aggravated by prolonged standing and lifting. On examination, the gait and hip ROM were normal. There was hip discomfort with certain hip movements. Lower extremity strength was normal. 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 report of pain with motion and some reduced motion due to pain.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated each hip 10% coded 5299-5255 (impairment of the femur) citing pain and functional loss. The VA similarly rated each hip 10% coded 5255 for the left hip and 5099-5020 (synovitis) for the right hip citing slight decreased ROM with use, pain on motion and slight knee or hip disability. The active ROM at both the MEB and the post-separation VA C&P examination do not support a minimum rating under the diagnostic codes based on limitation of thigh motion 5250 (ankylosis), 5251 (limitation of extension), 5252 (limitation of flexion), or 5253 (limitation of abduction, adduction or rotation). The left hip impairment was due to a stress fracture and the residual functional impairment correlates with the slight knee or hip disability due to mal-union of the femur, code 5255. The Board did not conclude the evidence supported the next higher rating for the left hip under this code for moderate disability. There was no fracture of the right hip and imaging was reported as normal. The right hip pain was attributed to strain due to compensation for the left hip pain. A 10% rating is supported based on functional loss. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hip pain.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the LBP and right shoulder pain conditions were not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. According to the MEB NARSUM, the CI developed LBP during physical therapy for hip pain but that the LBP improved. Examination of the back demonstrated full ROM without pain, tenderness or muscle spasm. Lower extremity strength was normal. She also developed right shoulder pain while using crutches, but was noted to be improving at the time of the MEB NARSUM examination. Examination of the shoulder was normal without limitation of motion, painful motion, weakened movement or examination findings of any shoulder disorder. The LBP and right shoulder pain conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards. The conditions were reviewed and considered by the Board. There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the LBP and right shoulder pain conditions and so no additional disability ratings are recommended.


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 pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the right hip pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended LBP and right shoulder pain conditions, the Board unanimously recommends no change from the PEB determination of not unfitting. 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 20140506, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150010468 (PD201402079)


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

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