RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Military Police, medically separated for “bilateral proximate femoral stress fractures/reactions” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20040701	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Proximate Femoral Stress Fractures /Reactions…	5099-5003	0%	No VA Exam in Evidence	
Right Foot Bunion	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Femoral Stress Fractures.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hip conditions began in January 2004 after falling on ice during a ruck march.  After initial treatment, follow-up radiographs revealed bilateral proximal femoral stress fractures, left greater than right.  The right stress fracture was specifically noted as, “milder, early stress fracture.”  Despite physical therapy (PT) and reduced activities, her treatment did not result in improvement sufficient to allow unrestricted duty.  

At a 10 May 2004 PT evaluation, 2 weeks prior to the NARSUM, the CI noted improved function and specifically stated, “Therapy definitely did help with recovery.”  She further indicated having reduced pain to 3/10 and on occasions “…had no pain at all.”  Her physical examination (PE) revealed a non-antalgic gait and full, but painful motion of both hips.  At the 24 May 2004 MEB NARSUM examination, 2 months prior to separation, the CI complained of bilateral hip pain (left greater than right) aggravated by marching, running, crawling, maneuvering stairs, or prolonged standing greater than 15 minutes.  “[The CI] reported over the past couple of weeks she had improved significantly, but cannot train.”  Her PE revealed painful, but normal range of motion (ROM) of both hips with regard to flexion.  The right hip was minimally decreased in external rotation at 40 degrees (normal 45), abduction at 35 degrees (normal 45), and adduction at 20 degrees (normal 45).  The ROM of her left hip revealed adduction at 20 degrees.  There was no VA Compensation and Pension examination contained in the case file and therefore, the panel's final impairment rating recommendation will be based upon the STR and MEB-related documents.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral proximate femoral stress fractures at 0%, analogously coded 5003 (arthritis, degenerative), citing degenerative arthritis without significant loss of joint motion.  The panel first considered whether each painful hip/leg condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  Although subjective complaints and radiologic imaging revealed that the left hip/leg appeared worse than the right, the objective clinical evidence nearest to separation remained essentially equivocal to both lower extremities without significant indication of either hip/leg being more impaired than the other.  The preponderance of clinical evidence throughout the STR mostly described adverse findings as ‘bilateral’.   Panel members agreed the clinical evidence as presented in this case would involve a high degree of speculation to conclude the disability either separately confined to one hip/leg or a combination of both hips/legs (PEB’s rating) would have rendered the CI incapable of performing her military duties and therefore, making her unfit for continued military service.   Panel members agreed to liberally invoke VASRD §4.3 (reasonable doubt) and concede in favor of the CI that the persistent pain with activities such as running, marching, crawling, maneuvering stairs, or prolonged standing rose to the level that each hip/leg, as an isolated condition, would have rendered the CI incapable of continued military police duties; and, accordingly recommends separate ratings for the right and left lower extremities.   

All panel members agreed that the evidence of painful bilateral hip motion would support a 10% impairment rating for each hip in accordance with VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends separate impairment ratings of 10% for the right hip and 10% for the left hip. 

Contended PEB Condition:  Right Foot Bunion.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the  panel concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the right foot bunion condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral proximate femoral stress fractures condition, the  panel unanimously recommends 10% for each hip coded 5022 in accordance with VASRD §4.71a.  In the matter of the contended right foot bunion condition, the panel unanimously recommends no change from the PEB’s determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel 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	
Left Proximate Femoral Stress Fracture	5022	10%	
Right Proximate Femoral Stress Fracture	5022	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/atchs
Exhibit B.  Service Treatment Record

AR20170007454, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure