RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03101
BRANCH OF SERVICE:  Army  	                        SEPARATION DATE:  20080827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Computer/Detection Systems Repairer, medically separated by the Informal Physical Evaluation Board (IPEB) for “stress fractures of the right femoral neck, proximal femurs and distal tibias,” with a disability rating of 20%.   

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 - 20080607	VARD - 20081230  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Thigh Pain from Right Femoral Stress Fracture	5299-5255	20%	Right Femoral Stress Fracture with Pain	5255	10%	20081024 	
			Left Femoral Stress Fracture	5255	10%	20081024	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Thigh Pain from Right Femoral Stress Fracture.  The service treatment records (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) indicated the CI had tibial pain during basic training.  X-rays dated 12 January 2007 of the left tibia and fibula demonstrated thickening of the distal third of the fibula cortex, which was probably developmental, although another report noted that it could be related to a stress fracture.  A bone scan dated 17 January 2007 revealed evidence of stress reaction in the posterior medial aspect of the upper femur bilaterally and bilateral shin splints.  A follow-up bone scan on 29 March 2007 demonstrated findings consistent with healing stress fractures involving proximal femurs bilaterally and shin splints involving distal tibias bilaterally.  A third follow-up bone scan dated 7 November 2007 revealed a mild shin splint of the right tibia and a suggestive stress fracture of the right femoral neck and post traumatic or stress changes of the right distal femur, which was interpreted as a stress fracture at the tension side of the right femoral neck and a right shin splint.  A hip/knee alignment series in November 2007 showed no evidence of malalignment or leg length discrepancy.  In December 2007 the CI reported distal right thigh pain and pain in the left thigh near the knee.  He also had bone pain in the right leg and the left leg with weight bearing, standing, rapid walking, running, carrying weight, and wearing gear.  He had no motor or sensory disturbances and had good coordination.  A note in January 2008 indicated the CI had been treated with limitations in activity, a P2 profile, nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen, without any change in symptoms.    

The commander’s statement dated 26 December 2007 indicated the CI was physically incapable of reasonably performing his duties due to bilateral leg pain, which prevented him from marching, wear TA-50, firing an assigned weapon, driving a military vehicle, deploying, and performing all field duties.  For the MEB examination, the CI reported on the DD Form 2807-1 Report of Medical History dated 1 January 2008 a stress fracture in the hip.  The MEB physical examiner noted on the DD Form 2808 Report of Medical Examination dated 26 February 2008 “Legs (Bilateral)--Tenderness to palpation—distal thigh.  No edema, nor erythema.  Diffuse TTP (tenderness to palpation) - anterior tibia.  Leg pain (B/L) elicited by ROM (range of motion) (knee, hip).”
  
The NARSUM, dated 23 April 2008, indicated the CI complained of right thigh pain 4 weeks into basic training. Because of persistent symptoms with running and wearing individual body armor, the CI was referred for an MEB.  With rest and time the pain in his bilateral shins improved.  On examination there was no tenderness to palpation over the anterior aspect of the left shin and thigh, but there was some mild tenderness with no stepoff of the midshaft along the anterior surface and some mild deep pain with no palpable mass overlying the right thigh region distal aspect where the fracture was located.  The CI’s gait, neurologic evaluation, and distal pulses were normal.  A permanent L3 profile was issued on 28 May 2008 for bilateral leg pain with limitations of the 2 mile run and all functional military activities except wearing a protective mask and all chemical defense equipment.  Additional restrictions included no individual body armor, no rucking, no side straddles, hops, flutter kicks, no running, and no jumping and the CI was a non-surgical candidate
  
At the VA Compensation and Pension (C&P) examination dated 24 October 2008, performed 2 months after separation, the CI reported bilateral femoral stress fractures that occurred during repetitive running and described the pain as aching, sharp and cramping with a severity of 10/10 (10 being the worst pain).  Examination of the right hip showed no signs of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement.  The left hip showed no signs of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement.  The ROM measurements of the right and left hip joints were flexion 125 degrees; extension 30 degrees, adduction 25 degrees, abduction 45 degrees, external rotation 60 degrees, and internal rotation 40 degrees.  Joint function bilaterally was not impaired with repetition. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating (10% right and 10% left) using code 5299-5255 (femur impairment-malunion with slight knee or hip disability) for bilateral thigh pain from a right femoral stress fracture.  The VA assigned NSC (not service connected), not subject to compensation using code 5299 for bilateral shin splints.  Although the PEB recorded the diagnosis as bilateral thigh pain, it actually assigned individual ratings for the left and right thigh (femur) conditions; therefore, further uncoupling analysis is unnecessary.  The Board then discussed whether the CI warranted a higher rating, but was unable to find a route in the absence of hip ankylosis (code 5250), thigh limitation of flexion to 30 degrees or less (5252), thigh impairment (5253), hip, flail joint (5254), or femur impairment with moderate knee or hip disability (5255).  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 bilateral condition.  

BOARD FINDINGS:  In the matter of the bilateral thigh pain from right 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.  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 20140323, 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 XXXXXXXXXX, AR20160011312 (PD201403101)

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
(  ) DV