RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02729
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20020916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Boatswain’s Mate, medically separated for “residual right thigh pain, status post right femur fracture,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

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 based upon a 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 - 20020614	VARD - 20021227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Residual Right Thigh Pain…	5255-5299-5003	10%	
Residual Fracture, Mid-Shaft Right Femur
	5266
	 
30%
	
20020610
	
Right Leg Length...Bone Loss	Cat II					
Right Thigh Atrophy…	Cat II					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Residual Right Thigh Pain S/P Femur Fracture.  The narrative summary (NARSUM) noted direct trauma that resulted in a proximal right femur fracture in February 2001.  Surgery was performed (closed reduction and internal fixation) at that time.  Persistent pain prompted subsequent removal of hardware in November 2001.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The Medical Evaluation board (MEB) forwarded “right thigh atrophy secondary to pain restriction,” along with two associated Category II conditions for PEB adjudication.  
The majority of the orthopedic and physical therapy entries in the pre-separation period documented full or near full hip and knee range of motion (ROM), with intermittent tenderness of the anterior or medial thigh, and an antalgic gait that improved to normal.  There was consistent documentation of subjective and objective hip or thigh pain at routine appointments, and before and after physical therapy.  

The MEB NARSUM examination was performed on 16 April 2002 (5 months prior to separation).  The CI reported medial thigh pain that increased with activities and carrying more than 20 pounds.  The examiner documented no significant rotational deformity, and tenderness of the thigh and at the healed fracture site.  Ankle and knee ROMs were normal.  

At the VA general medicine Compensation and Pension (C&P) examination dated 22 April 2002, the CI reported persistent pain that caused difficulty with movement.  The examiner documented a limp.  At a second VA C&P examination dated 10 June 2002, the CI additionally reported pain, weakness, stiffness, instability, locking, fatigue, and lack of endurance and denied any limitations in standing or walking.  The examiner documented a limp and wear of a shoe lift.  Hip flexion was to 125 degrees (normal), abduction was to 45 degrees (normal), with decreased adduction to 25 degrees (normal45).  The knee examination was normal with full flexion and no evidence of laxity or meniscal injury.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the “residual right thigh pain, s/p right femur fracture” and two additional Category II conditions as unfitting, combined and rated at 10%, analogously coded 5255-5299-5003 (femur, impairment of; degenerative arthritis).  The VA rated 30% for the “residuals, fracture, mid-shaft, right femur,” coded 5255 (femur, impairment of; with marked hip disability) and cited a normal painful and limited hip motion, with full ROM of the knee.  

Application of VASRD §4.59 (painful motion), §4.40 (functional loss) and §4.45 (the joints) was supported by documentation (painful motion and mechanical limitations of the hip) justifying a 10% rating coded as 5255 (femur, impairment of, with slight hip disability).  There was no evidence of nonunion of the femur, with or without loose motion; no documentation of weight bearing preserved with aid of brace; and no evidence of a false joint in support of a higher than 10% rating.  There was no evidence of malunion of the femur that resulted in a moderate or marked degree of hip or knee disability in support of a higher rating.  There was no evidence of ankylosis (5250), abduction limited to 10 degrees (5253), or flexion limited to 30 degrees (5252).  There was no evidence of knee impairment for coding under VASRD applicable knee codes.  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 right hip condition.  

BOARD FINDINGS:  In the matter of the right hip 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.  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 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 6 Jul 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)