RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00725
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040322

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “status post percutaneous pinning of [right] femoral neck stress fracture” with a disability rating of 0%.

CI CONTENTION:  The CI made no 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 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 - 20040226	VARD - 20041020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…[Right Hip] Femoral Neck Stress Fracture	5099-5003	0%	…Fracture Right Femoral Neck…	5255	0%	20040921	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Right Femoral Neck Stress Fracture.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right hip injury on 20 September 2003.  He underwent corrective percutaneous (three screws fixation) surgery on 18 November 2003 for a complete, non-displaced femoral neck [hip] stress fracture.  The CI had no complications postoperatively and experienced some mild pain in the region of the right hip for which he took mild analgesics.  The MEB forwarded “right femoral neck stress fracture” for PEB adjudication.

At the NARSUM examination on 7 January 2004, less than 3 months prior to separation, the CI had a forward flexion of the right hip of 100 degrees, internal rotation of 10 degrees, external rotation of 60 degrees, and abduction of 40 degrees.  There was minimal tenderness to palpation over the area of the incision.  The screws were not prominent.  There was full motor strength in the foot, ankle and knee and the range of motion (ROM) of the knee was painless.  X-rays showed a well healed femoral neck stress fracture with evidence of increased sclerosis through tension and compression sides and the hip was anatomically reduced.  The NARSUM examiner noted that according to medical literature “military patients who undergo treatment for femoral neck stress fractures have a poor prognosis for return to active duty.”  At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 5 February 2004, approximately 1 month prior to separation, the CI reported a fracture of the hip, subsequent surgery, and the use of crutches when he fractured his hip.  Physical examination revealed the CI walked with a cane and limped.  

At the VA Compensation and Pension (C&P) examination on 21 September 2004, performed 6 months after separation, the CI reported he was free of pain in the right hip and had no stiffness or limitation of motion.  Follow-up X-rays showed a healed stress fracture of the neck of the right femur.  On examination he walked without assistance and his gait and posture were normal.  He had a well-healed, stable scar on the right hip without any tenderness, swelling, erythema, or increased temperature.  The ROM measurements were forward flexion 95 degrees, abduction 70 degrees, internal rotation 30 degrees and external rotation 20 degrees.  There was no reduction in function or ROM with repetition.  X-rays of the right hip on 21 September 2004 showed two screws at the proximal right femur indicating prior fixation of fracture; however, there was no acute fracture or dislocation and no degenerative changes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (arthritis, degenerative), citing the hip was anatomically reduced.  The VA also assigned a 0% rating for the residuals stress fracture right femoral neck status post pinning using the 5255 code (femur, impairment of) based on the VA C&P examination 6 months after separation, citing “a noncompensable evaluation was assigned unless there was malunion of the femur with slight knee or hip disability.”  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of thigh flexion, extension, or impairment (5252, 5251, or 5253).  The examination proximate to separation did not demonstrate the presence of hip ankylosis (5250) or hip, flail joint (5254).  However, there was a repaired full stress fracture of the neck of the femur (5255), but at the time of separation there was no nonunion or a false joint.  Nevertheless, although there was no malunion per se, use of an analogous code 5299-5255 is not unreasonable since the CI did have at least slight hip disability at the time of separation since he walked with a cane and limped.  A higher rating of 20% for moderate hip disability is not warranted since post-separation the CI walked without assistance and there was no significant change in flexion from 9 months earlier.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 10% for the right femoral neck stress fracture, coded 5299-5255.  

BOARD FINDINGS:  In the matter of the right femoral neck stress fracture condition, the Board majority recommends a disability rating of 10%, coded 5299-5255 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Femoral Neck Stress Fracture	5299-5255	10%	

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, AR20170002448 (PD201500725)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA