RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300113
BRANCH OF SERVICE:  Army	BOARD DATE:  20140206
SEPARATION DATE:  20020314 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (96H10, Common Ground Station Operator) medically separated for a left hip condition.  He sustained a left femoral neck fracture in basic training which required surgical pinning and precluded the rigors of advanced individual training.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501, and no other conditions were submitted.  The PEB adjudicated “left femoral neck fracture” (noting surgical residuals) as unfitting rated at 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Injury has severely impacted my way of life, physically and emotionally.  I was unable to hold my children due to weight constraints, no heavy lifting, unable to stand or sit for long periods of time.  … [CI elaborates severity of current symptoms and disability.] …  It has caused secondary injuries.  Degenerative arthritis, abdominal pain, radiating nerve pain down my left leg, abdominal hernias from the straining, and right hip over-compensation that is now service-connected and the use of a cane has been issued and is used frequently.  I've used a cane since my discharge from service, at which time I was issued one at the military hospital.  I still have physical limitations today, similar to those from the service.  It is very painful in colder weather, and rainy wet environments.”

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 left hip condition (with consideration for the possibly associated degenerative arthritis and “radiating nerve pain down my left leg” as referenced in the contention) is addressed below.  The abdominal hernias and right hip conditions referenced in the application were not identified by the MEB or PEB are not within the DoDI 6040.44 defined purview of the Board.  These and any other condition or contention not requested in this application remains eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service PEB – Dated 20010212	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Femoral Neck Fracture	5299-5003	10%	Left Femoral Neck Fracture	5299-5255	10%**	STR	
No Additional MEB/PEB Entries	Other x 0	STR	
Combined:  10%	Combined:  10%	
* Derived from VA Rating Decision (VARD) dated 20021016 (most proximate to date of separation (DOS))
** Rating increased to 20% by VARD dated 20101027, effective 20100129 (date of claim), based on C&P exam of 20101006.

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications (e.g., arthritis) of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Left Hip Fracture.  The CI experienced a sudden onset of left hip pain during a long distance ruck march near the end of basic training.  He attempted to continue training and was not X-rayed until nearly 2 weeks later, when he fell and experienced severe pain with inability to ambulate.  At that time he was identified with a displaced femoral neck fracture and underwent prompt open reduction with internal fixation (surgery).  A secure aligned fixation was confirmed fluoroscopically.  The CI was placed on profile restrictions and underwent physical therapy.  The service treatment record (STR) documented significant activity limitations and a limp with the use of a cane.  Range-of-motion (ROM) measurements post-operatively were initially flexion 80 degrees (normal 125, 10% minimum = 45) and external rotation of 25 degrees (normal 45, 10% minimum = 15); and, later (9 weeks pre-separation) were flexion 90 degrees and external rotation 40.  There is no STR evidence for, or refuting, a compensable limitation of abduction or adduction.  There is no STR evidence for, or clinical likelihood of, any nerve damage or associated arthritis at the time of separation (as relevant to the contention).  The orthopedic consultant opined that long term outcome would not be compatible with military service and MEB proceedings were initiated in lieu of continuing with further training.  The narrative summary (NARSUM) noted constant pain rated 4/10 exacerbated by cold weather and stair climbing.  The examiner described a slight limp, favoring the right, with occasional use of a cane (crutches for severe flares).  The physical exam noted a healed incision with local tenderness, and there was quadriceps atrophy with decreased left hip strength.  The orthopedist opined that long term recovery to full function was unlikely, with permanent limitations of running and heavy load bearing.  The recorded ROMs were flexion 80 degrees, external rotation 20 and extension 5 (normal 20, 10% minimum = 5).  There is no probative post-separation VA examination in evidence.

The Board directs attention to its rating recommendation based on the above evidence.  Although the record documents post-separation worsening of the hip condition with arthritis, arthritis was not evident at the time of separation.  There was no indication of peripheral nerve injury related to the hip condition.  The PEB’s 10% rating analogously to 5003 (degenerative arthritis) was not disadvantageous to rating under any of the VASRD §4.71a limitation of motion codes for the hip, although the 5 degrees extension documented in the NARSUM supports an alternative 10% rating under code 5251 (thigh, limitation of extension).  The VA’s 10% rating (applying same evidence as above) was analogous to 5255 (femur, impairment of) which offers a 10% rating for “slight,” 20% for “moderate” and 30% for “marked” hip disability.  Analogous 5299-5255 is the only available code under §4.71a which would permit a rating higher than 10% in this case.  Members agreed that this analogous coding choice (5299-5255) complies with VASRD §4.7 (higher of two evaluations) and that the hip disability in evidence at separation, including all symptoms, could be fairly characterized as moderate.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left hip condition under code 5299-5255.

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 20%, coded 5299-5255 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 Femoral Neck Fracture with Surgical Residuals	5299-5255	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130313, w/atchs
Exhibit B.  Service Treatment Record
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

AR20140013239, 

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

						     

Enclosure