RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04348
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Initial Entry Trainee (68W), medically separated for “slight hip disability due to impairment of femur,” with a disability rating of 10%.

CI CONTENTION:  “Please 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 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 – 20080722	VARD – 20090527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Slight Hip Disability	5255	10%	Residuals, Stress Fracture of Femoral Neck, Right Leg	5255	10%	20090925	
Adjustment Disorder	Not Unfitting	Adjustment Disorder	9440	0%	STR	
Sensorineural Hearing Loss	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Slight Right Hip Disability.   According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in March 2008 while running his first Army physical fitness test.  He was given a 2-week profile and felt better; however when he took his second test, he experienced pain in the hip that was worse than the previous episode.  A bone scan dated 24 April 2008 revealed a right basal cervical femoral neck fracture on the compressive side and magnetic resonance imaging (MRI) on 28 April 2008 demonstrated a Grade IV right femoral neck stress fracture on the compressive side that was treated non-surgically.  X-rays on 4 June 2008 of the right hip demonstrated a healing stress fracture of the compressive side of the right femoral neck with curvilinear sclerosis.  The pain in the hip was generally associated with walking and prolonged standing.  

Despite treatment, the right hip condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “right Grade IV femoral neck stress fracture” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated May and June 2008, approximately 2 months prior to separation, the CI reported impaired use of the right leg/hip due to stress fracture and right hip pain.  The examiner did not record any findings related to the hip.  The NARSUM examination dated 24 June 2008, 2 months prior to separation, demonstrated moderate to severe  tenderness within the right groin area, but was non-tender to palpation over the greater trochanter or posteriorly.  The CI had a negative Patrick’s test (to determine hip pathology), was able to cross his legs without difficulty and had an out-toeing of approximately 70 degrees.  There was no quadriceps or hamstring atrophy noted.  Active range of motion (ROM) of the right hip was flexion of 100 degrees, extension 15 degrees, abduction 45 degrees, adduction 28 degrees, external rotation 40 degrees and internal rotation 35 degrees, whereas flexion of the left hip was 110 degrees and the remainder of the left hip measurements were essentially the same as the right hip.  The right knee was unremarkable for edema or effusion.  There was no patellar tilt or laxity and there was a negative grind test.  ROM measurements of the right knee were 0-130 degrees flexion and 10 degrees of extension and there was no laxity or evidence of a meniscal tear.  

At the VA Compensation and Pension (C&P) examination in February 2009, performed 6 months after separation, the CI reported he was unable to sleep on the right and had difficulty crossing his legs; however, he was able to walk, but could not run or jump.  He was not taking any medication and did not use either a cane or crutches.  ROM of the right hip was flexion of 125 degrees and abduction 40 degrees.  Extension, adduction, external rotation and internal rotation were not measured. There was pain at the extreme of flexion and no pain on abduction.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5255 code (femur impairment), citing slight hip disability due to impairment of the femur.  The VA also assigned a 10% rating using the 5255 code based on the VA C&P examination 6 months after separation, citing residuals, stress fracture of femoral neck, right leg.  Board members discussed alternative rating options; however, in the absence of hip ankylosis (code 5250), thigh limitation of extension (code 5251), thigh limitation of flexion (code 5252), thigh impairment (code 5253), hip flail joint (code 5254) or femur impairment with moderate knee or hip disability (code 5255), there was no route to a higher rating.  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 slight right hip disability condition.  

Contended PEB Conditions-Adjustment Disorder and Sensorineural Hearing Loss.  The Board’s main charge is to assess the fairness of the PEB’s determination that the adjustment disorder and sensorineural hearing loss conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The adjustment disorder was not profiled and sensorineural hearing loss was given an H2 profile.  Neither condition was implicated in the commander’s statement nor was either judged to fail retention standards.  There was no performance-based evidence from the record that the adjustment disorder and sensorineural hearing loss 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 determination for either condition; and so, no additional disability ratings are recommended.  
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.  In the matter of the contended adjustment disorder and sensorineural hearing loss 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 20141206, 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 
, AR20160018414   (PD201404348)

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