RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00613
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E2, Basic Trainee, medically separated for “stress fracture of the right femoral,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that she “has problems from her injury…” which continues to worsen and negatively impacts her daily activities.  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 - 20080801	VARD – None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture of the Right Femoral…	5299-5255	10%	No VA Examination in Evidence	
Left Hip…	“…underwent complete healing without pain…”		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Stress Fracture of the Right Femoral Neck (Hip).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began in April 2008 after periods of prolonged running, rucking, and marching.  Magnetic resonance imaging showed a stress fracture (fx) involving greater than 50 percent of the right femoral neck and a stress fx involving 25 percent of the left femoral neck.  The CI underwent percutaneous pinning of the right hip fx on 2 May 2008.  During 30 days convalescence leave her pain improved markedly.  However, she still had aching pain of the right hip improved by pain medication and rest.  She did not have left hip pain.  The MEB NARSUM noted the CI was not going to be able to complete basic training due to the need for prolonged recovery for this type of injury.  The MEB forwarded “bilateral femoral neck fractures” for PEB adjudication.  The MEB NARSUM examination on 21 July 2008, 1 month prior to separation, noted complaints of dull aching right hip pain, increased by weight bearing activities.  Physical examination showed the hips were symmetric with normal range of motion (ROM).  The CI reported pain with right hip flexion greater than 90 degrees.  Hip strength was normal and sensation and pulses of the lower extremities were intact.  Physical therapy measured ROM for the MEB on 25 June 2008.  Hip flexion was 130 degrees (normal 125), extension was 13 degrees (normal 20) and abduction was 36 degrees (normal 45).  At the time of the MEB NARSUM exam the CI was still restricted to limited weight bearing following normal protocol following a pinned hip fracture.  The MEB NARSUM indicated the CI’s right hip pain was not unusual for her injury at this time and that she was at increased risk for re-injury until complete fx healing took place, which could take well over a year.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, under the analogous coded 5255 (femur, impairment of), citing “hip malunion with a slight residual hip disability.”  The PEB utilized the 5255 code for femur impairment with slight hip disability, which provides a 10% rating.  There was no evidence of “moderate” hip disability in this case for higher rating under 5255, as the CI was still in the normal convalescent period for a stress fx that required surgical pinning and she was improving without complications.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of thigh flexion, extension, or thigh impairment (5251, 5252, 5253).  The examinations proximate to separation did not demonstrate the presence of hip ankyloses or flail hip joint (5250, 5254) for a rating under the respective codes.  There was therefore no route to a rating higher than the 10% adjudicated by the PEB under any applicable VASRD §4.71a 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 hip condition.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s de facto determination that the contended left femoral neck (hip) stress fx was not unfitting.  The left femoral stress fx was not permanently profiled.  The MEB NARSUM examination noted the CI was diagnosed with left femoral neck fx involving less than 25% of the femoral neck.  The CI had surgical pinning of the right hip as noted above, but the left femoral neck stress fx was treated conservatively.  The commander’s statement noted only that the CI was unable to complete basic training.  At the MEB NARSUM examination, the CI was still convalescing from right hip surgery but reported that she did not have left hip pain.  There was no performance based evidence from the record that the left hip condition would have by itself caused the CI to be referred into the physical disability process.  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 the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the stress fracture of the right femoral neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left femoral neck stress fracture condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150530, w/attachments
Exhibit B.  Service Treatment Record

AR20170005102, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure