RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01811
BRANCH OF SERVICE:  Army	BOARD DATE:  20140423
SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92R2O/Parachute Rigger) medically separated for a left femur condition.  The left femur pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P2/L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic pain in the left femur and diabetes were forwarded to the Physical Evaluation Board (PEB) as not meeting medical standards.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic pain in the left femur as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The US Army Physical Disability Agency performed an Administrative Correction, only correcting the disability description.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his 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 those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left femur condition is addressed below.  The not unfitting diabetes condition was not contended and, thus is not within the DoDI 6040.44 defined purview of the Board.  Any condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

PDA Admin Correction – Dated 20041007	VA* - (5 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain in the Left Femur	5099-5003	10%	S/P Open Reduction Internal Fixation, Femur Fracture Left	5255	10%	20050513	
Diabetes	Not Unfitting	Diabetes Mellitus, Type II	7913	20%	20050513	
No Additional MEB/PEB Entries	Other x 2	20050513	
Combined:  10%	Combined:  40%	
*Derived from VA Rating Decision (VARD) dated 20050912 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VASRD standards, based on ratable severity at the time of separation.

Chronic Pain in Left Femur.  After undergoing surgery for the isolated proximal left femur fracture in April 2002, the CI experienced an uncomplicated course.  Five months post-operatively, he was walking long distances without a cane and complaining of no pain.  However, by 10 months after surgery he was experiencing persistent thigh pain.

On 19 May 2004 (7 months prior to separation), the orthopedic MEB addendum examiner noted that the CI did not need narcotic medication for pain.  He complained of constant pain in the left thigh and buttock that could awaken him from sleep.  Pain was worse with walking; he could not run or jump.  Physical exam noted a normal gait and difficulty rising from a squat.  Tenderness of the left buttock, but not the thigh, was present.  Moderate left thigh (quadriceps muscle) atrophy was noted.  There was no visible leg length discrepancy.  There was no change in range-of-motion (ROM) measurements after three repetitions.  X-rays showed one centimeter of femur shortening, a well-healed proximal femur fracture and properly positioned surgical hardware.

At the VA Compensation and Pension exam on 13 May 2005 (5 months after separation), the CI reported constant pain and catching in the hip.  He complained of difficulty running and squatting.  Examination showed equal leg lengths.  He required no assistive devices, but gait was “abnormal” due to limitation of left hip motion.  After repetitive use, fatigue and weakness were reported to additionally limit joint function.  Repetitive motion measurements were not provided.  Muscle strength was normal.  Painful motion was specified for internal rotation only.

The goniometric ROM evaluations in evidence 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 Ortho
7 Mos. Pre-Sep	VA C&P 5 Mo. Post-Sep	
Flexion (125 Normal)	105	125	
Extension (20)	0	30	
External Rotation (45)	40	60	
Abduction (0-45)	--	45	
Adduction (45)	--	25	
Comment	+tenderness	+painful motion 	
§4.71a Rating	PEB 10%	VA 10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis).  The VA likewise rated the condition at 10%, but under the 5255 code (impairment of femur).  The Board agreed that a 10% rating was justified under 5251 (compensable limitation of extension at time of MEB exam), or for functional loss (§4.40) or painful motion (§4.59).  The Board considered a route to a higher rating under the 5255 code.  “Slight” hip disability justifies a 10% rating, while “moderate” disability warrants a 20% rating.  Board members considered an abnormal gait which was attributed to limitation of hip motion by the VA examiner, yet the exam documented normal hip flexion and extension.  The exam noted a normal gait, but difficulty arising from a squatting position was present.  It was agreed that “slight” disability best describes the evidence at hand and therefore a 10% rating is recommended.  Board members finally debated the application of VASRD §4.45 in this case, which allows for the next higher rating if evidence of additional functional loss after repetitive motion is evident, but agreed that available evidence did not support that approach.  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 adjudication for the chronic pain of the left femur.

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 chronic pain in the left femur 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

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, AR20150001001 (PD201301811)

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						
						         
CF: 
(  ) DoD PDBR
(  ) DVA