RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01615
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Operating Room Specialist, medically separated “chronic right thigh pain weakness and mild atrophy due to right distal thigh injury” with a disability rating of 10%.

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 - 20060310	VARD - 20081125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Thigh Pain Weakness and Mild Atrophy	5314	10%	Right Thigh Condition	5251	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Right Thigh.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right thigh condition began as teenager when she received two surgeries for a right distal femur cartilage (knee) in 1994, followed by a right distal femur non-ossifying fibroma in 1995.  She received additional surgery on 7 February 2005 (16 months before separation) for right thigh partial-thickness rectus muscle tear.

The commander’s statement from 22 November 2005 indicated that the CI was unable to perform many duty tasks because the CI could not push heavy loads or push carts due to right leg pain and subsequent right knee swelling.
The 10 February 2006 MEB NARSUM examination, 4 months before separation, noted complaints of worsening right distal thigh pain.  The CI was unable to run or jump, and had difficulty with prolonged standing.  Physical examination revealed right knee range of motion (ROM) of 0 to 135 degrees (extension to flexion normal 0 to 140) with painful motion.  Lachman’s (instability) and McMurray’s (meniscus) testing were negative.  Mild knee tenderness and pain with lateral patellar movements were present.  Right lower extremity motor strength was 5/5 (normal) but quadriceps muscle strength was decreased at 4+/5 and there was decreased distal quadriceps muscle circumference compared to the left (atrophy).  There was palpable defect or palpable scar tissue within the distal aspect of her quadriceps and muscle that was underlying a well-healed incision to the knee cap.  The CI was tender over the palpable defect and over the repair area.  There was no neurovascular deficit.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right thigh 10% (moderate), coded 5314 (Muscle Group XIV. Function:  Extension of knee), citing worsening pain and weakness.  The VA did not service-connect the right thigh condition, coded 5251 (thigh, limitation of extension), citing no evidence of a current right thigh condition based on no available medical evidence after discharge.

The panel deliberated if the CI’s muscle injury more nearly approximated the moderate (10%) or moderately severe (30%) muscle injury rating criteria IAW VASRD §4.73 and the tenants of §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities).  The record indicated that the CI had cardinal signs and symptoms of muscle disability with weakness, and lowered threshold of fatigue, and fatigue-pain.  There was no through and through or deep penetrating muscle wound, no debridement or prolonged infection, no retained fragments, no sloughing of soft parts, or prolonged hospitalization for treatment.  The panel deliberated if the slight quadriceps muscle weakness (4+/5), distal quadriceps atrophy, and palpable defect or palpable scar tissue represented intramuscular scaring or deep muscle scarring as under the moderately severe criteria and if that were sufficient for a higher rating; however, the panel adjudged that the evidence in its entirety supported no higher than a 10% moderate muscle disability as adjudicated by the PEB.

There was femur impairment pathology to support an alternative analogous consideration under code 5255 for a femur-knee or femur-hip disability; however, the panel adjudged that there was no more than a slight (10%) knee or hip disability which did not rate higher than the 10% awarded by the PEB.  There was no limitation of hip or knee motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5251, 5252, 5253, 5260, or 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no VASRD §4.71a or §4.73a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 thigh condition.

BOARD FINDINGS:  In the matter of the right thigh condition and IAW VASRD §4.73, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008828, 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