RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00471
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-3, Trainee, medically separated for “left thigh pain” with a disability rating of 10%.   

CI CONTENTION:  The CI wrote “see attached documents” as his contention on the application.  The attached documents did not indicate a specific contention.  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 upon a 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 - 20080516	VARD – 20150122 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Thigh Pain…	5299-5255	10%	Left Hip Trochanteric Pain Syndrome with Tendonitis and Bursitis S/P Left Femur Fracture with Retained Hardware	5255-5252	10%	20141103	
			Scars, Left Trochanteric Region and Left Distal Thigh	7804	10%	20141103	
			Left Knee Strain Associated with Left Hip 	5260	10%	20141103	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Thigh Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left thigh pain condition began in September 2007 after falling on the physical endurance course and sustained a left nondisplaced distal left femoral spiral fracture.  On 11 September 2007, he underwent intramedullary nailing (open reduction and internal fixation (ORIF) of bone) and had follow-up physical therapy.  Healing was such that he tried to return to duty.  

At the MEB examination on 4 February 2008, 4 months prior to separation, the CI reported a fractured left femur and [insertion] of a rod and four screws.  The examiner noted a well-healed scar from the ORIF femur fracture.  A note dated 11 February 2008 indicated that X-rays showed the fracture to be completely healed and the operative wounds were well healed with no signs of infection.  However, when running he had thigh pain.  He was completely healed at 7 months after surgery, but could not run more than a mile due to leg pain or walk more the 45 minutes to an hour before pain stopped him.  Range of motion (ROM) measurements are in the chart below.  

At the remote VA Compensation and Pension (C&P) examination on 3 November 2014, performed 6 years and 5 months after separation, the CI reported some degree of left leg and thigh pain with increased activity, prolonged weight bearing, high-impact activity, and cold weather.  He took Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)) as needed.  He described popping and clicking in the left hip region.  X-rays did not demonstrate any significant degenerative changes of the left hip, but he did develop some tendonitis and bursitis secondary to changes in biomechanics and some pain, discomfort, and intermittent swelling of the left knee.  ROM measurements are in the chart below.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.   

Left Hip (Thigh) ROM
(Degrees)	PT ~4 Mo. Pre-Sep	MEB ~1 Mo. Pre-Sep	VA C&P ~6 Yrs, 5 Mos. Post-Sep	
Flexion (125 Normal)	112	112	125	
Extension (20)	10	10	30	
External Rotation (45)	-	36	60	
Abduction (0-45)	39	39	45	
Adduction (45)	-	18	25	
Comment	Limitations due to pain and muscle tightness likely from scar tissue following surgery; no limitations noted with functional adduction and external rotation	Pain at the end of motions; no loss of motion with repetition	Pain on exam did not result in/cause functional loss; muscle strength normal	
§4.71a Rating	10%	PEB 10%	VA 10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5255 code (femur impairment), citing a left nondisplaced distal femur fracture requiring an ORIF with residual thigh pain.  The VA also assigned a 10% rating using an analogous 5255-5252 code (femur, impairment-thigh, limitation of flexion) based on the VA C&P examination 77 months after separation, citing left hip trochanteric pain syndrome with tendonitis and bursitis, status post left femur fracture with retained hardware.  Despite not being in the scope of review, the VA assigned a 10% rating using code 5260 (leg, limitation of flexion) based on the same remote VA examination, citing left knee strain associated with left hip trochanteric pain syndrome with tendonitis and bursitis, status post left femur fracture with retained hardware and a 10% rating using code 7804 (scar(s), unstable or painful-one or two scars that are unstable or painful), citing scars, left trochanteric region and left distal thigh.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5251, 5252, and 5253). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  While the PEB used an analogous code 5299-5255 for slight knee or hip disability, the STRs at the time of separation did not provide sufficient evidence to warrant a 20% rating or above for moderate or marked knee or hip disability nor was there any hip ankylosis (5250) as a 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 left thigh pain condition.  

BOARD FINDINGS:  In the matter of the left thigh 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 20150602, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170000127 (PD201500471)

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