RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04095
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080201
DATE PLACED ON TDRL:  20060721            
DATE REMOVED FROM TDRL:  20080201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, projected to become a Patriot Launching Station Enhanced Operator/Maintainer, but medically separated from the Temporary Disability Retired List (TDRL) for “right hip pain status post femoral neck fracture and percutaneous pinning,” with a disability rating of 10%.

CI CONTENTION:  The CI requested an accuracy review of her disability separation.  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 – 20060721/20080415	VARD – 20070105	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Right Hip Pain	5299-5255	30%	10%	Right Femoral Neck Fracture	5255	60%	60%	
Right Hip Pain Status Post Femoral Neck Fracture and Percutaneous Pinning	5099-5003							
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  
	
Right Hip Pain Status Post Femoral Neck Fracture and Percutaneous Pinning.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a surgical pinning of her right hip on 5 April 2006 secondary to a displaced right femoral neck fracture.  Despite aggressive rehabilitation efforts, her treatment did not result in improvement sufficient to allow unrestricted duty.  On 21 July 2006, the CI was placed on the TDRL with a 30% impairment rating.  At the MEB examination 10 May 2006, leading to TDRL entry, the CI’s chief complaint was “My right hip bothers me.”  Her physical examination (PE) revealed limited and painful motion of the right hip noting flexion and extension measurements above VASRD minimal compensable levels.  Both abduction and adduction measurements were not documented.  Her diagnosis remained unchanged from the MEB’s initial submission.  At the VA Compensation and Pension (C&P) examination performed on 28 September 2006 (2 months after TDRL entry), the CI’s PE revealed painful and limited hip motion noting adduction of 10 degrees.  X-rays obtained at this time noted the “suggestive evidence” of non-union.     

The TDRL re-evaluation examination was performed on 29 March 2007 (8 months after TDRL entry) whereby the CI reported a constant/aching pain about the right hip aggravated by prolonged standing, walking, and sitting.  The CI indicated the feeling that her painful condition had “gotten worse” during the TDRL period.  Her PE revealed a further decrease in range of motion (ROM) with pain.  Hip extension was measured at 5 degrees (normal = 20 degrees) and although the degree of hip adduction was not documented, the provider noted the CI’s inability to cross legs (indicative of adduction impairment).  Repeat X-rays revealed the intact surgical hardware and “no radiographic evidence of complication.”  The corresponding PEB of 19 June 2007 permanently separated the CI at 10% impairment, citing pain and the requirement for daily opiates.  

The case file contained frequent and often subjective comments in regards to radiographic findings of bony non-union.  Both in late 2006 and 2007, X-ray reports referenced a “high probability” and “low probability” of there being a condition of non-union, respectively.   However, X-ray reports throughout 2007 (January, February, March, and July) all indicated either normal, no complications, or expected post-surgical hardware/changes.      

The Board directed attention to its rating recommendation based on the above evidence.  Upon TDRL entry, the PEB rated the right hip condition at 30% utilizing two separate analogous codes of 5255 (femur impairment) and 5003 (degenerative arthritis), whereas the VA rated 60% under 5255 citing “probable” nonunion of bone.  Board members first agreed that the presented evidence did not support a rating higher than the 30% at TDRL entry noting non-compensable ROM parameters and the absence of loose hip motion.  Board members then focused their attention on finding evidence for a §4.71a rating higher than the 10% permanent rating adjudicated by the PEB at TDRL termination.  Although the CI believed that her painful condition had “gotten worse” during TDRL, the PE findings of limited 5 degrees of extension, as well as the inability to cross legs, would rate no greater than 10% impairment.  Additionally, the reported repeat X-ray statement of “no radiographic evidence of complication” clearly indicated the absence of non-union or mal-union.  Therefore, 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’s permanent 10% rating upon TDRL exit.  

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, 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 
AR20160017815 (PD201404095)

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