RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01630
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “left femoral neck stress fracture (complete),” with a disability rating of 0%.

CI CONTENTION:  “Decreased mobility and increased pain and discomfort.”  The CI’s 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 - 20020916	VARD - 20021224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Femoral Neck Stress Fracture (Complete) 	5099-5003	0%	Residuals, Left Femoral Neck Fracture 	5255	10%	20021204	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Femoral Neck Stress Fracture (Complete).   According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left femoral neck stress fracture (complete) condition began in April 2002 after falling down stairs.  In April 2002 the CI underwent surgical reduction and fixation of the displaced left femoral neck stress fracture.  At an orthopedic follow-up dated June 2002, 6 weeks after surgery, the CI denied pain.  The physical examination showed full left hip range of motion (ROM) with “slight” pain with internal rotation.  

The 20 August 2002 MEB NARSUM examination, 2 months prior to separation, noted complaints slight hip pain with vigorous walking and severe hip pain with running.  ROM showed left hip flexion to 110 degrees (normal 125), extension to 40 degrees (normal 20), internal rotation 40 degrees, external rotation to 60 degrees (normal 45), abduction 60 degrees (normal 45) and adduction 40 degrees (normal 45).  The examiner noted pain with extremes of internal rotation of the left hip.  The groin area was non-tender to palpation.   

At the 04 December 2002 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported pain in the area of the upper thigh; especially with cold, wet weather or with over-activity.  The CI stated minimal walking and was unable to sit for no more than 45 minutes due to pain.  The CI was unable to run, jog, or lift more than 40 pounds. She denied the use of assistive devices for ambulation or pain medication.  Physical examination showed a non-tender vertical scar on the lateral surface of her upper thigh.  Motor strength of the left hip was normal.  ROMs exhibited was flexion to 110 degrees; abduction to 35 degrees; adduction to 25 degrees; external rotation to 35 degrees; and internal rotation to 15 degrees.  There was no diminution in any of the ROMs with repetitive testing.  Radiographic findings, 04 December 2002, showed three surgical pins in the left femoral neck region with some sclerosis (hardening of the tissue) of the femoral neck.  There was no evidence of avascular necrosis (bone degradation due to loss of blood supply) or fracture lucency (malunion).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left femoral neck stress fracture (complete) condition 0%, coded 5099-5003 (arthritis degenerative), citing pain in the extremes of motion.  The VA rated the left femoral neck fracture condition 10% coded 5255 (Femur, impairment of), based on the C&P examination 2 months after separation, citing slight hip limitation of motion as a residual of the femoral neck fracture.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5252 or 5251).  There was not sufficient limitation of abduction or adduction for a rating under 5253 (thigh impairment of).  There was no nonunion or malunion of the femur to support consideration under the respective codes for hip impairment (5254, 5255).  However, there was evidence of painful motion supporting a 10% rating (based on §4.59).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating 10% for the left femoral neck stress fracture (complete) condition, coded 5255. 

BOARD FINDINGS:  In the matter of the left femoral neck stress fracture (complete) condition, the panel unanimously recommends a disability rating of 10% coded 5255, IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The Board 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 Femoral Neck Fracture (Complete)  	5255	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150619, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170008725, 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,