RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00264
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20061206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Vehicle Management and Analysis Journeyman, medically separated for left hip condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFSC) or satisfy physical fitness standards.  She was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB).  The “chronic left femur pain due to retained symptomatic hardware status post femur fracture with open reduction and internal fixation” and “left hip pain secondary to symptomatic hardware” were forwarded to the Physical Evaluation Board (PEB) AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left femur pain due to retained hardware status post femur fracture with open reduction and internal fixation,” as unfitting, rated 10% IAW Veterans Affairs Schedule for Rating Disabilities (VASRD).  She was also noted to be overweight.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Due to the stiffness in my leg, and the fear of pain I no longer do the things I did before my car accident.  My left leg is no longer as flexible as the right.  I notice that I stand differently just to ease the pressure placed on my left leg.  I still have stiffness and pain around the hip, and as the years go by there is no improvement.”  Her complete submission is at Exhibit A.

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 20061023	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Femur Pain…	5299-5255	10%	Left Hip Bursitis…	5255	20%	20070404	
			Scar, Residual of Left Femur…	7805	0%	20070404	
Other x 0 (Not In Scope)	Other x 3 (Not In Scope)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070509 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Left Femur Pain Due to Retained Hardware Status Post Femur Fracture with Open Reduction and Internal Fixation Condition.  The record shows that the CI was in a motor vehicle accident on 3 May 2004 and sustained a fracture of the mid-shaft of the left femur.  She underwent an open reduction and internal fixation (ORIF; the bone fragments were re-approximated with internal hardware) the same day.  She underwent rehabilitation following surgery and was able to return to modified duty.  However, she had pain with increased activity.  She was given an injection which provided temporary pain relief.  She declined further injections and surgery to remove the hardware.  Her final fitness report, which closed out on 10 April 2006 recommended immediate promotion and noted that she volunteered as a flight line photographer at official functions.  At an orthopedic appointment on 21 June 2006, she had a normal gait and posture.  Flexion and extension were noted to be normal and her scars were well healed.  She noted that she reported no difficulties with work in garrison, but did not think that she could meet the demands of deployment.  She was therefor issued an L4 profile and referred for an MEB.  The narrative summary (NARSUM) evaluation was dated 31 July 2006, 4 months prior to separation.  The examiner noted that the CI had been placed on intermittent profiles for the past 2 years.  Her gait was normal and scars well healed.  The range-of-motion (ROM) was full for flexion, extension, as well as internal and external rotation and symmetric with the unaffected right hip.  X-rays showed a well-healed fracture without evidence of arthritis in the hips.  At the VA Compensation and Pension (C&P) examinations performed on 4 and 13 April 2007, 4 months after separation, the CI reported that she was able to stand for a hour and walk 1/4-mile.  Her ROM met or exceeded VA normal values except for adduction which was limited to 25 degrees.  The scars were well healed.  She was tender near the hip and diagnosed with left hip greater trochanteric bursitis (inflammation of a fluid sac near the hip).  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left hip at 10%, coded 5299-5255 (impairment of the femur).  The VA also used the 5255 code, but rated the hip at 20%, citing moderate impairment.  The scars were coded 7805 (scars) and determined to be non-compensable.  The C&P examiner noted that the CI was limited in walking and standing; however, the CI reported to the MEB examiner that she had no problems performing her peace time military requirements, but was concerned about the demands of deployment.  The reported function to the MEB examiner is consistent with a mild impairment as is her ability to take photographs at flight line functions.  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 left femur condition.  

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 femur condition 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 re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140102w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00264.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings