RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03647
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Computer/Detection System Repairer, medically separated for “right medial subtrochlear stress fracture,” with a combined disability rating of 10%.  

CI CONTENTION:  The applicant makes no contention in her application.  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 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 - 20051201	VARD - 20060530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Medial Subtrochlear Stress Fracture…	5099-5003	10%	Status Post Stress Fracture to the Right Thigh…	5299-5255	10%	20060510	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Medial Subtrochlear Stress Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI complained of persistent hip and lower leg pain that was not relieved with a temporary profile and the use of nonsteroidal anti-inflammatory drugs.  A bone scan dated 19 September 2003, demonstrated an acute stress fracture in the proximal right femoral shaft, a periosteal stress reaction of the lateral proximal femoral shaft, and a mild overuse injury at the tibiotalar joint of the left ankle.  The MEB NARSUM dated 27 October 2005, recorded that the CI, after sustaining a right femoral stress fracture in the subtrochlear region medially, was able to return to duty with conservative treatment.  A note dated 5 July 2005, indicated the CI had pain in the right thigh for 2 weeks without a specific injury, but began to hurt during a run at her own pace and distance after not having run for 8 months.  On examination, the right thigh was tender on palpation and there was pain in the mid-shaft of the right femur with an axial load.  X-rays of the right hip were normal.  A follow-up bone scan dated 14 July 2005, revealed a focus of minimal cortical stress reaction of the proximal third of the femur.  As a result, the CI resumed the use of crutches.  X-rays of the right hip dated 26 August 2005, revealed a periosteal stress reaction of the proximal femur corresponding precisely to the zone of increased uptake on the bone scan a month earlier.  By 25 October 2005 the right hip joint, neck and shaft of the femur and the bones around the knee joint showed no evidence of a stress fracture or changes of shin splints.  A permanent L3 profile was issued for status post right proximal femur stress fracture with limitations of all functional military activities and physical fitness testing; weight bearing as tolerated was permitted.

At the NARSUM examination dated 27 October 2005, the CI was using crutches and had a full range of motion (ROM) of the right hip with tenderness to palpation on her right anterior medial thigh over the area of the stress fracture.  Her right knee had a full ROM and her right lower extremity was neurovascularly intact distally.  At the MEB examination, the CI reported (on DD Form 2807-1 dated 28 October 2005), that she had a stress fracture of the right femur and was unable to bear weight on the right leg.  The MEB physical examiner did not note any abnormalities of the lower extremities on the DD Form 2808, but did list the stress fracture of the right femur under the defects and diagnoses section.  The commander’s statement dated 28 October 2005, indicated the CI was physically incapable of reasonably performing her duties as a special device technician, particularly in a tactical environment, due to the limited mobility incurred as a result of her leg injuries.  

At the VA Compensation and Pension (C&P) examination dated 10 May 2006, performed 3 months after separation, the CI reported suffering from pain located at the right lower thigh, which was marked by burning and aching.  The pain level was 6/10 (10 being the worst pain).  Treatment was with Motrin (Ibuprofen, an NSAID).  She noted it hurt to run and lift objects and she could not walk a long distance.  On examination her posture and gait were normal as were the right femur and right knee.  The right hip showed no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement or guarding of movement.  The ROM measurements of the right hip were flexion 125 degrees, extension 30 degrees, adduction 25 degrees, abduction 45 degrees, external rotation 60 degrees, and internal rotation 40 degrees.  Joint function was not additionally limited by repetition.  X-rays of the right hip on 10 May 2006, 3 months after separation, revealed no fractures, dislocations or osseous abnormalities.  Mineralization was normal as were the articular soft tissues; and, the joint spaces were well maintained.  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.

Right Hip (Thigh) ROM
(Degrees)	MEB ~4 Mo. Pre-Sep
	VA C&P ~3 Mo. Post-Sep
	
Flexion (125 Normal)	Full ROM
	125	
Extension (20)		30	
External Rotation (45)		60	
Abduction (0-45)		45	
Adduction (45)		25	
Comment	Tenderness to palpation right anterior medial thigh over the area of the stress fracture	DeLuca negative	
§4.71a Rating	PEB 10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating using code 5099-5003 (degenerative arthritis) for a right medial subtrochlear stress fracture confirmed by X-ray.  The VA assigned a 10% rating using code 5299-5255 (femur impairment malunion with slight knee or hip disability) for status post stress fracture to the right thigh.  The Board sought a route for a higher rating, but was unable to find one in the absence of ankylosis, further limitation of motion of flexion or abduction, nonunion of the femur, or moderate disability of the knee or hip.  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 medial subtrochlear stress fracture condition.  

BOARD FINDINGS:  In the matter of the right medial subtrochlear 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 20140804, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160008697 (PD201403647)

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