RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01248
BRANCH OF SERVICE:  Army  	 SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Motor Transport Operator Trainee) medically separated for stress fractures of both femurs.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic bilateral thigh pain with healing early stress fractures of bilateral femurs was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated bilateral femoral stress fractures as unfitting, rated at 10% each, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her 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 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 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 20090102	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Femoral Stress Fractures	5299-5255	20%	Bilateral Femoral Stress Fractures	5299-5262	0%	20090409	
Other x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090514 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Bilateral Femoral Stress Fractures Condition.  The record shows that the CI developed bilateral hip pain during week 7 of basic training.  A bone scan on 9 June 2008 showed changes consistent with bilateral stress fractures as did X-rays on 15 July 2008.  Despite duty limitations including 30 days of convalescent leave, she continued to have pain.  Although X-rays on 8 August 2008 were normal, she was thought to be at high risk of recurrent problems if training were continued.  She was then entered into the MEB process.  Range-of-motion (ROM) measurements in physical therapy (PT) on 9 October 2008 were slightly limited in flexion, but pain free.  The examiner specifically noted that the CI could cross her legs (left over right and right over left), did not have a limitation in abduction over 10 degrees, and did not have a limitation in external rotation limiting her to 15 degrees toe-out (all VASRD rating criteria).  The MEB narrative summary (NARSUM) was dated 20 November 2008, 2 months prior to separation.  It noted the above history and ROM measurements.  The CI reported ongoing pain aggravated by activity.  Her motor function was normal.

At the VA Compensation and Pension (C&P) examination performed on 9 April 2009, just over 2 months after separation, the CI reported no functional impairment from the femoral stress fractures.  Her gait and posture were normal.  Both hips were tender, but the ROM was normal and pain was present with motion in all planes and aggravated by repetition.  X-rays were normal as was her strength.  The examiner determined that the condition was resolved.  The 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.

R/L Hip (Thigh) ROM
(Degrees)	PT for MEB
~3 Mo. Pre-Sep	VA C&P
~3 Mo. Post-Sep	
Flexion (125 Normal)	120	125	
Extension (20)	10	30	
External Rotation (45)	--	60	
Abduction (0-45)	45	45	
Adduction (45)	--	25	
Comment	Pain free motion	Painful motion	
§4.71a Rating	0%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated each hip at 10%, coded 5299-5255 (Analogous to impairment of the femur, slight disability).  The VA rated the hips at 0% noting that the condition had resolved, but used the code 5299-5262 (Analogous to impairment of the tibia and fibula).  The Board noted that this is not a correct code for the hips.  The Board considered these and other codes available for the hip condition, but found no route to a higher rating.  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 fitness determination for the bilateral femoral stress fracture 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 bilateral femoral stress fracture 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 20140310, 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 XXXXXXXXXXXXXXXXXX, AR20160003667 (PD201401248)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA