RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03850
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Small Arms Repairer, medically separated for “right proximal femur fracture with delayed union,” with a disability rating of 20%.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          , increased impaired vision, headaches, TBI, knee and back pain.  Joint pain in left hand…Seeking treatment for PTSD due to motor vehicle accident that occurred during service.”  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 on 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 - 20040617	VARD - 20041015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Proximal Femur Fracture with Delayed Union	5255	20%	Residuals, Right Femur Fracture with Status Post Intramedullary Rod and Exchange Nail Procedure	5255	20%	20040707	
Left Second Metacarpal Fracture Healed	Category III	Status Post Left Hand Second Metacarpal Bone Fracture	5229	0%		
Status Post I&D		Status Post Left Knee Peripatellar Bursa Hematoma and Laceration with Incision and Drainage	5299-5260	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Proximal Femur Fracture with Delayed Union.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right femur condition began in November 2002 after a motor vehicle accident.  He underwent surgery within hours for a comminuted right hip fracture with placement of an intramedullary rod.  The hip fracture was not healing on serial radiographs and the CI underwent two additional procedures, including replacement of the rod in the hip (exchange nailing).  Despite physical rehabilitation, at the end of the second period of limited duty, the CI was unable to complete the physical readiness test and he was referred to for a MEB.  The MEB forwarded “right proximal femur fracture with leg union left knee,” “status post I&D,” “left second metacarpal fracture healed,” and “hereditary spirochetosis” [dictation mistake for spherocytosis], for PEB adjudication.

During the MEB NARSUM examination on 6 May 2004, 3 months prior to separation, the CI reported pain in the right hip and a “sense of weakness” at the fracture site when running or lifting over thirty pounds.  The physical examination noted that all surgical scars of the right hip were well healed and non-tender.  Hip range of motion (ROM) was flexion of 35 degrees (normal 125 degrees), abduction of 30 degrees (normal 45 degrees), and normal external rotation.  Lower extremity strength was normal.

At the 7 July 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported stabbing pain in his right leg with aching in his back.  He reported shortening of the right leg which affected his gait and caused some foot pain, as well as being unable to bend over.  The physical examination noted an “almost normal gait, considering his leg lengths are unequal.”  The right leg length was 94 centimeters (cm) compared to 96 cm on the left.  The right hip ROM was flexion of 90 degrees with pain and all other ROM was normal.  The right knee ROM was normal and pain with strenuous exertion was noted.  The knee was stable with no evidence of meniscal pathology or joint effusion.  Right lower extremity strength, sensation, and reflexes were normal.  Right femur X-rays noted an old healed fracture of the femur with associated myositis ossificans (calcification within muscle after trauma-may be painful) at the fracture site.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right femur fracture condition 20% coded 5255 (femur impairment).  The VA rated the right femur fracture condition 20% coded 5255 (femur impairment), based on the VA C&P examination 1 month before separation, citing decreased hip ROM with pain on flexion.  There was no evidence of marked hip or knee disability, a “false joint” at the site of the fracture, or nonunion of the femur fracture to support a higher rating than 20% as adjudicated by the PEB under the 5255 code.  There was no limitation of thigh flexion (5252) to support higher rating, and no history of a flail (5254) or ankylosed hip joint (5250) to support a rating under the respective codes.  Finally, if rated alternatively for shortening of the right lower extremity (5275) by 2 centimeters compared to the left, the minimum rating of 10% was not achieved.  There is therefore no VASRD §4.71a route to a rating higher than the 20% adjudicated by the PEB under any applicable code.  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 proximal femur fracture condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the status post I&D (incision and drainage of the left knee laceration) and the left second metacarpal fracture healed conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the status post I&D and the left second metacarpal fracture healed conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right proximal femur fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended status post I&D (incision and drainage of the left knee laceration) and the left second metacarpal fracture healed conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140819, 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 21 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXXXX	     				  			  		 Assistant General Counsel
						 (Manpower & Reserve Affairs)