RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02216
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an  E2, Wheeled Vehicle Mechanic, medically separated for “stress fracture, left distal femur” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20070817	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Left Distal Femur	5099-5003	0%	No VA Claim in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Stress Fracture, Left Distal Femur.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left distal femur stress fracture condition began in September 2006.  The MEB forwarded “stress fracture, left distal femur” for PEB adjudication.  The 29 June 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of left knee pain varying from 2/10 to 5/10 made worse with activity or running.  Physical examination showed he could walk without crutches. His gait was minimally antalgic.  He held his left knee in slight flexion.  Knee alignment was normal.  Both hips had normal full painless range of motion (ROM).  Examination of the CI's knees revealed no effusion or synovitis.  Knee alignment was normal.  There was no instability.  Patella tracking was normal.  Compression of the patellofemoral joints did not cause pain.  He was diffusely sore to palpation over the distal femur and proximal tibial on the left.  There was no warmth or edema.  The left knee ROM measurements showed 140 degrees (normal 140) of active flexion and -5 degrees (normal 0) of extension (after 3 repetitions).  16 May 2007 magnetic resonance imaging of the left distal femur and knee revealed as femur stress fracture and mild chondromalacia.  At the 17 July 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported ongoing knee trouble.  Physical exam showed pain to palpation over the left distal femur.  There was no VA claim by the CI in the evidence of record.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left distal femur stress fracture condition 0%, analogously coded 5099-5003 (degenerative arthrits), citing continued to have pain and inability to train.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  There was no non-union, or malunion fracture of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, the panel concluded that there was sufficient evidence of painful motion and functional loss to support a 10% rating for each knee IAW §4.59, §4.40 and §4.45.  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 left distal femur stress fracture condition, coded 5255.

BOARD FINDINGS:  In the matter of the left distal femur stress fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5255 IAW VASRD §4.71a.  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 Distal Femur Stress Fracture	5255	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150710, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012127, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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