RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-03651
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20021212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “right hip pain,” with a disability rating of 0%.

CI CONTENTION:  The CI requests the Board 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 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 -  Dated 20021024	VARD - 20030303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hip Pain	5099-5003	0%	Status Post. Right Femoral Neck Stress Fracture	5252	0%	20030121	
Major Depressive Disorder, Single Episode	Not Unfitting 	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Hip Condition.  According to Service treatment records (STR) and the medical evaluation board (MEB) narrative summary (NARSUM), the CI sustained a right hip injury during Advanced Individual Training (AIT), approximately 10 months prior to referral for MEB.  At an orthopedic surgery evaluation, the CI complained of left groin pain 2-3 weeks prior while running.  Pelvis diagnostic imaging (X-ray) revealed an old healed left pubic ramus fracture and a new superolateral (tension side) right femoral neck stress fracture (repetitive stress induced fracture).  
Because of the high risk of fracture displacement, the orthopedic surgeon recommended surgical percutaneous fixation.  On 5 February 2002 the CI underwent right hip percutaneous pinning of the tension side stress fracture.  At the 6 week postoperative orthopedic surgery follow-up, the CI was still on crutches and reported having little right hip pain.  The 10 cm right hip lateral incision appeared to be healing satisfactorily with no evidence of infection.  The incision staples were removed.  A right hip X-ray showed three cannulated screws in good position and the fracture in good position and alignment.  The orthopedic surgery MEB addendum recounted the history and interventions.  The CI complained of right hip pain of 0-2/10 at rest, up to 5/10 lying on it, and up to 8/10 with prolonged weight bearing or intermittent trauma.  Active range-of-motion (ROM) was flexion of 120 (125 normal), extension of 30 (20), external rotation of 40+ (45), and abduction of 50 (45) degrees.  A right hip X-ray revealed excellent fracture alignment with excellent bony contact and a well-developed callus.  There were no signs of hardware failure or displacement, early degenerative joint disease, or avascular necrosis (lack of blood supply causing bone death) of the femoral head.  The orthopedic surgeon documented “All of these are outstanding results for this fracture.  She has well over a 99% chance of going on to an excellent union and excellent result.”  The diagnosis listed right nondisplaced complete femoral neck fracture status post close reduction/internal fixation with three parallel screws.  A 9 October 2002 family medicine MEB addendum physical examination documented the CI walked without crutches and with no limp.  The right hip examination revealed a mildly tender and well-healed lateral surgical scar (8 centimeters).  Active ROM was flexion of 90 (125), extension of 10-15 (20), external rotation of 45 (45), and abduction of 50 (45) degrees.  A pelvis X-ray revealed a healed right femoral neck stress fracture with retained hardware (three screws), a healed left femoral neck stress fracture, and a healed left inferior pubic ramus stress fracture.  In the 31 January 2003 compensation and pension (C&P) examination, 2 months after separation, the CI complained of right hip morning stiffness lasting 20-30 minutes.  She reported right hip pain with lying in the right recumbent position and with prolonged sitting, driving, standing, and walking.  Symptoms were relieved by position or activity change.  The symptoms did not cause her to stop her activities, or miss any work, and she did not take any medications for this condition.  The physical examination documented a normal posture, stance, and gait.  The right hip examination revealed a non-tender and healed lateral surgical scar (5 centimeters).  Active ROM was flexion of 110 (125), extension of 20 (20), external rotation of 55 (45), and abduction of 45 (45) degrees.  A right hip X-ray revealed an apparently fully healed (not visible) fracture with retained hardware (three cannulated screws) and no evidence of avascular necrosis.  The diagnosis listed status post-surgery, with closed reduction and internal fixation in the right femoral neck.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing right hip pain, history of a stress fracture during AIT, ambulates without crutches and without a limp, rated for pain in accordance with the USAPDA pain policy.  The VA assigned a 0% rating under the 5252 code (thigh, limitation of flexion of) based on the VA C&P examination 2 months after separation, citing status post right femoral neck stress fracture, three screws placed in hip, ROM, and no evidence of an arthritic condition.  While the CI underwent right hip percutaneous pinning, X-rays showed a healed fracture with no evidence of nonunion or malunion for consideration under 5255 (femur fracture nonunion/malunion of).  There was no compensable limitation of motion for consideration under 5251 (thigh, limitation of extension of) or 5252 (thigh, limitation of flexion of).  There was no evidence of disability for consideration under 5250 (hip, ankylosis of), 5253 (thigh impairment of abduction, adduction, rotation of), or 5254 (hip, flail joint).  Board members agreed a 10% rating was justified IAW §4.40 (functional loss) and §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right hip condition, coded 5252.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the major depressive disorder, single episode condition was not unfitting.  While the contended condition was profiled, it was not implicated in the commander’s statement and was not judged to fail retention standards.  The major depressive disorder, single episode condition was reviewed and considered by the Board.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the major depressive disorder, single episode  condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right hip condition, the Board unanimously recommends a disability rating of 10%, coded 5252 IAW VASRD §4.71a.  In the matter of the contended major depressive disorder, single episode condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Hip Pain	5252	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140730, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017196 (PD201403651)

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 10% 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