RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01061
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic right hip pain due to femoral neck stress fracture…,” with a disability rating of 10%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20090513	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hip Pain due to Femoral Neck Stress Fracture..	5299-5255	10%	VA Examination not in Evidence	
Lower Back Pain	Not Unfitting		
Right Knee Pain	Not Unfitting		
Pregnancy	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Hip Pain due to Femoral Neck Stress Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip pain began in November 2008 while running during basic training.  Radiographic imaging detected a stress fracture of the right femoral neck, which required closed reduction with percutaneous pinning on 10 December 2008.  Follow-up X-rays in February 2009 showed the stress fracture to be “essentially healed” and hardware position to be normal.

Range of motion (ROM) measurements performed by physical therapy on 24 February 2009 (3 months prior to separation) found right hip flexion of 75 degrees (normal 125), extension of 12 degrees (normal 20), and abduction of 40 degrees (normal 45).  External rotation was described as toeing-out greater than 15 degrees and adduction was described as the ability to cross legs.  Painful hip motion was present.  An antalgic gait was present, but there was no muscle atrophy.

The MEB NARSUM examination on 10 March 2009 noted a complaint of right hip pain that persisted despite surgery.  Pain was described as constant and would wake her frequently from sleep.  Prolonged sitting or standing exacerbated her pain.  She could not walk on the treadmill or run.  Physical examination showed an antalgic gait favoring the right side.  After 3 repetitions, right hip flexion was 65 degrees (normal 125), extension 15 degrees (normal 20) and abduction 30 degrees (normal 45).  External rotation was described as toeing-out greater than 15 degrees.  Adduction was reported as “unable to completely cross the right leg over the left.”  

There was no VA examination in evidence within the 12-month allowable window for adjudication

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip pain 10%, coded 5255 (femur, impairment of), citing limitation of adduction and functional loss.  A 10% rating under the 5255 code requires that the hip disability is “slight,” while the next higher 20% rating is described by “moderate” hip disability.  Panel members agreed that “slight” was most accurately described by the evidence, therefore the 10% rating was justified.  A higher rating was either not available or not warranted under the respective codes for limitation of extension, flexion, abduction, adduction or external rotation (5251, 5252, and 5253).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right hip pain.  

Contended PEB Conditions: Lower Back Pain, Right Knee Pain, and Pregnancy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.   

BOARD FINDINGS:  In the matter of the right hip pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended low back pain, right knee pain and pregnancy conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150609, with attachments
Exhibit B.  Service Treatment Record

AR20170008428, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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