RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01224
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060904

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “chronic left thigh pain,” with a disability rating of 10%.  

CI CONTENTION   The CI made no specific contention in their application.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB - 20060525	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Thigh Pain	5099-5003	10%	Residuals of Comminuted Fracture of Middle Third of the Left Thigh and Left Knee Disabilities	5255	10%	20060817	
			Surgical Scars, Three, of the Left Lower Extremity	7804	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Thigh Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fractured his left femur while running backwards on 16 May 2004.  This was treated surgically with good approximation of the fracture.  He then underwent rehabilitation in physical therapy (PT), but had persistent pain.  Hardware was then removed on 25 August 2004 and 12 September 2005.  An X-ray dated 27 September 2005 documented the fracture was completely healed in a near anatomic position and all hardware had been removed.  On 1 February 2006, 7 months prior to separation, the commander noted that the CI was able to perform his administrative duties in garrison, but that he would not do well in a deployed environment with increased physical demands; reclassification was recommended.  At the NARSUM, dated 8 February 2006, the CI reported the surgical scar interfered with the wear of military gear.  It was noted the CI no longer had muscle atrophy and could cycle at his own pace and distance.  He could not meet physical fitness standards though.  On examination, his gait was normal and he could rise and sit in a chair without difficulty.  The hip scar and fracture site were tender to deep palpation.  The range of motion (ROM) of the knees was normal and the knees were without laxity.  Formal ROM testing at PT on 26 April 2006, 4 months prior to separation, showed full ROM of the hips and knees.  In orthopedics on 2 May 2006, he was noted to have a normal gait and full ROM of the knees and hips.  Laxity of the joints was absent.  The VA Compensation and Pension (C&P) examination was performed on 17 August 2006, 18 days before separation.  The CI reported painful motion of the left hip.  The ROM of the knee was normal, but with quadriceps atrophy (contrary to earlier documents) was noted.  A limp was not present.  The scars were non-tender to palpation although the CI reported that they were painful.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing pain and utilizing the US Army pain policy, which was in effect at that time.  The VA also assigned a 10% rating using the 5255 code (impairment of the femur, with malunion and slight knee or hip disability) based on the VA C&P prior to separation.  The VA also rated the scars at 10%, coded 7804 (painful scars) for noted tenderness.  The Board considered the evidence and determined the 5255 code utilized by the VA best described the CI’s impairment.  No route to a higher rating was found though; however, the scars were noted to interfere with the wear of military gear.  This supports a finding that the scars were separately unfitting and ratable.  A 10% rating, coded 7804, is supported by the evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends that the thigh pain condition be recoded to 5255 with no change in the rating and the addition of a separate disability rating of 10% for the post-surgical scars condition, coded 7804.  

BOARD FINDINGS:  In the matter of the chronic left thigh pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the post-surgical scars condition, the Board unanimously agrees that it was unfitting and unanimously recommends a disability rating of 10%, coded 7804 IAW VASRD §4.118.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Thigh Pain	5255	10%	
Post-surgical Scars	7804	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140304, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160009929 (PD201401224)

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,
accept the Board's recommendation to modify the individual's disability rating to 20%
without re-characterization 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:

CF:
( ) DoD PDBR
( ) DVA