RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01286
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “right femoral neck stress fracture…”  with a disability rating of 10%.

CI CONTENTION:  The CI reports her condition continues to worsen and negatively impact daily activities.  The 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 - 20061017	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Femoral Neck Stress Fracture…	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Femoral Neck Stress Fracture...  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured her right hip approximately 4 months prior to referral for an MEB.  A 3 June 2006 right hip diagnostic imaging study (MRI) showed an inferomedial aspect (compression side) femoral neck stress fracture (repetitive stress-induced fracture).  An 11 June 2006 right hip X-ray showed no evidence of femur fracture.  In the 12 September 2006 NARSUM examination, 6 weeks before separation, the CI complained of 6 months of right femur pain with a crepitus (grating sensation or sound) sensation deep in her hip with excessive ambulation.  “She is currently ambulating with crutches; as a protective measure against further injuring her right femoral neck.  However, she states that she can ambulate quite well without crutches.”  Active medications were Percocet, Tramadol, and Feldene, which were used occasionally.  The last use of narcotics was in June 2006.  The examiner noted under the physical examination section, “Please see DD Form 2808 for the majority of normal findings.” The right hip examination revealed groin tenderness, no groin masses, and no tenderness over the posterior hip, greater trochanter (proximal lateral femur bony prominence), or lesser trochanter (proximal posteromedial femur bony prominence).  The Patrick test (assesses hip and sacroiliac joint pathology) was positive.  Goniometer-measured range of motion (ROM) was limited by pain.  Right hip flexion was 90 (125 normal), external rotation was 20 (60), internal rotation was 10 (40), abduction was 28 (45), and adduction was 28 (25) degrees.  Strength, sensation, and pulses were grossly intact.  The examiner opined that the CI was not a surgical candidate and recounted the findings of the MRI and X-rays.  The diagnosis listed right femoral neck stress fracture.  There was no VA Compensation and Pension evaluation in evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative) citing right femoral neck stress fracture by MRI, no neurologic abnormality, ROM limited by pain, intermittent narcotic use, slight and constant pain, and rated IAW U.S. Army Physical Disability Agency Policy pain policy. There was no compensable thigh limitation of extension (5251) or flexion (5252), or thigh impairment of abduction, adduction, or rotation (5253) for consideration under those respective codes.  There was no hip ankylosis (5250) or flail joint (5254) for consideration under those respective codes.  While there was a history of a right femoral neck stress fracture, there was no evidence of a completed femur fracture with nonunion or malunion (5255) for consideration under that 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005982, XXXXXXXXXXXXXXXXXX.  

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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,