RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00681
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “femur impairment” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively affect 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 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 – 20091123	VA – No VA Claim in Evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Femur Impairment	5255	10%					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Hip Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed right hip pain during the 3rd week of basic training in June 2009.  A 4 June 2009 diagnostic imaging (bone scan) study showed a right medial femoral neck stress fracture and on 9 June 2009, the CI underwent percutaneous screw fixation of his right femoral neck stress fracture.  A right hip X-ray revealed satisfactory appearance status post fixation.  The 27 August 2009 orthopedic surgery physical examination documented an antalgic gait with the assistance of crutches.  The right hip examination revealed a well-healed lateral surgical incision with appropriate peri-incisional tenderness to palpation.  
There was no erythema (redness), drainage, or fluctuance about the surgical site.  Pain-limited right hip range of motion (ROM) was flexion of 90 degrees (125 normal), abduction of 20 degrees (45 normal), and external rotation of 20 degrees (45 normal).  

The assessment listed chronic right hip pain, status post percutaneous screw fixation of femoral neck stress fracture.  On 28 September 2009, physical therapy (PT) measured right hip ROM for the MEB with a goniometer.  The physical examination documented the CI could cross his bilateral legs.  He had no limitation of abduction causing motion to be lost beyond 10 degrees, or limitation of external rotation causing inability to toe-out more than 15 degrees.  Pain-limited, repetitive (X3), right hip ROM was flexion of 110 degrees (125 normal), abduction of 35 degrees (45 normal), and extension of 10 degrees (10 normal).  The 6 October 2009 NARSUM, 2 months before separation, recounted the history and interventions.  Postoperatively, the CI did not experience significant improvement following PT and two consecutive 30-day periods of unit convalescent leave.  He complained of intermittent right hip pain that occurred daily.  Symptoms were exacerbated to 8/10 pain with all activity.  The CI did not take any medication for this condition.  The examiner documented “general physical exam was within normal limits.”  The right hip examination revealed normal gait and a well-healed lateral scar (2 cm), but no redness or depression.  There was tenderness over the femoral triangle, but no pelvic girdle, pubic symphysis, greater trochanter, or hip abductors tenderness.  There was hip joint pain with internal and external rotation, but no crepitus, snapping, or mechanical locking with ROM.  Strength, sensation, and pulses were normal.  The diagnosis listed chronic right hip pain, status post percutaneous pinning of femoral neck stress fracture.  

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 of) citing femur impairment, chronic right hip pain secondary to right femoral neck stress fracture, status post hip pinning, pain with ambulation, and ROM.  There was no compensable thigh limitation of extension (5251), thigh limitation of flexion (5252), or thigh impairment of abduction, adduction, or rotation (5253) for consideration under the respective codes.  There was no hip ankylosis (5250) or hip flail joint (5254), for consideration under the respective codes.  While there was a history of femoral neck stress fracture, status post percutaneous screw fixation, there was no evidence of femur fracture nonunion/malunion (5255) for consideration under the respective code.  Board members agreed a 10% rating was justified IAW §4.40 (functional loss) and §4.59 (painful motion).  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.  

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 20150603, with attachments
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, AR20160019448 (PD201500681)

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