RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01287
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E1, Basic Trainee, medically separated for “healed right femoral shaft fracture,” with a disability rating of 0%.

CI CONTENTION:  “Review all condition.”  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 conditions 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 - 20040902	VARD - 20050616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Healed Right Femoral Shaft Fracture	5255-5003	0%	Right Femoral Shaft Fracture with Retained Hardware	5255	10%	20050210	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Healed Right Femoral Shaft Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right femur fracture while running approximately 3 months prior to referral for MEB.  A 7 May 2004 right femur radiographic (X-ray) showed a mid-shaft comminuted (multiple fragments or splinters) fracture.  On 7 May 2004 the CI underwent a right femur closed reduction and intramedullary femoral nailing.  Serial right femur X-rays between May and July 2004 showed an intramedullary rod traversing the femur, anatomic alignment, mid shaft fracture lucency, and a large associated callous.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “completed fatigue fracture, right mid shaft femur” for PEB adjudication.

The 2 August 2004 MEB NARSUM, 3 months before separation, recounted the history and interventions.  Postoperatively, the CI recovered well and was ambulatory without aid.  He walked with a slight limp which was exacerbated with increased levels of activity.  The CI complained of persistent pain, particularly over the greater trochanter over the proximal locking screw.  The physical examination documented a Trendelenburg gait (gait dysfunction from weak hip abductors).  The focused right lower extremity examination revealed a well-healed incision.  There was tenderness over the proximal locking screw with no effusion (fluid collection) or edema (excess tissue fluid swelling).  Right hip range of motion (ROM) was “0 to 110 degrees.”  The leg was neurovascular intact distally.  The 16 July 2004 right femur X-ray showed hardware in good position without loosening, excellent alignment, and healing of the mid shaft fracture with copious callus formation.  The diagnosis listed completed fatigue fracture, right mid shaft femur.  The examiner opined “In the future, it is likely that he will require removal of his proximal screw secondary to the irritation.  It is not recommended at this time as the fracture needs more time to completely mature, but he should in the future years’ time or so be ready to do any full physical activity that he may desire.”  

On 4 August 2004 physical therapy (PT) measured repetitive (X3) ROM IAW VASRD.  Right hip active ROM was flexion of 124/123/120 (normal 120), extension of 15/15/14 (normal 15), adduction of 20/22/19 (normal 30), abduction of 72/70/72 (normal 45), external rotation of 24/22/22 (normal 45), and internal rotation of 42/43/42 (normal 45) degrees.  A 27 August 2004 right femur X-ray showed an intramedullary rod traversing a mid-shaft femur fracture, a callous formation, and no fracture lucency seen.  

The 10 February 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, recounted the history and interventions.  The CI complained of chronic aching proximal femur pain in the area of the arthroscopic scars.  Baseline pain was 3/10 and increased to 5-6/10 at night and with prolonged standing.  “He has no problem with walking except every few weeks, the leg will act like it might walk to give way as he walks.”  The CI denied falling, using a cane, or taking pain medication.  The physical examination documented “He is ambulating, with a very slight limp, favoring the right side.”  The focused right lower extremity examination revealed three well-healed surgical scars with no tenderness or adhesions.  There was no femur gross deformity or tenderness.  “Both hips flex 140 degrees and extend fully.  There is full abduction, adduction and circumduction.  He gets some mild increase in discomfort in this right hip area as we go through the circumduction.”  The diagnosis listed residuals of surgery for fractured right femur.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5255-5003 codes (femur, impairment of-arthritis, degenerative), citing healed right femoral shaft fracture and retained hardware in good position by X-ray.  The VA assigned a 10% rating under the 5255 code (femur, impairment of), based on the VA C&P examination 3 months after separation, citing right femoral shaft fracture, retained hardware, chronic aching pain, full ROM, and mild discomfort with circumduction.  

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 the CI underwent a right femur closed reduction and intramedullary femoral nailing, there was no femur fracture nonunion/malunion (5255) for consideration under the respective code.  Panel 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 panel recommends a disability rating of 10% for the healed right femoral shaft fracture condition, coded 5255-5003.  

BOARD FINDINGS:  In the matter of the healed right femoral shaft fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5255-5003 IAW VASRD §4.71a.  There were 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Healed Right Femoral Shaft Fracture	5255-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150613, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005983, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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