RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02350
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “left femoral neck stress fracture,” with a disability rating of 0%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 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 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 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 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 - 20040826	VARD - 20050922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Femoral Neck Stress Fracture	5099-5003	0%	Left Femoral Neck Stress Fracture, Status-Post
Cannulated Screw Fixation	5299-5252	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Femoral Neck Stress Fracture Condition.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a left hip injury in the 13th week of Advanced Individualized Training (AIT).  Left hip X-rays showed a left femoral neck stress fracture (repetitive stress induced fracture).  A nuclear medicine bone scan showed an inferomedial aspect (compression side) stress fracture which spanned 75% of the femoral neck.  On 10 May 2004 the CI underwent left femoral neck cannulated (hollow shaft) screw fixation with three (Synthes) screws.  The July 2004 postoperative left hip X-rays showed good placement of the three cannulated (Synthes) screws and healing of the left femoral neck fracture.  The 29 July 2004 MEB NARSUM examination by orthopedic surgery, 6 weeks prior to separation, recounted the history and interventions.  After the surgical procedure, the CI was made 50% weight-bearing as tolerated on the left lower extremity with crutches for 6 weeks.  Left hip pain was exacerbated by prolonged standing (> 20 min.), prolonged walking (> 1 mile), prolonged movement, running, marching, jumping, kneeling, jumping jacks, flutter kicks, sit-ups, and leg spreaders and relieved by bed rest, sitting, and swimming.  Physical examination documented repetitive (X3) active range of motion (ROM).  Pain-limited left hip ROM was flexion of 120 degrees (normal 125), extension of 0 degrees (normal 30), adduction of 30 degrees (normal 25), abduction of 45 degrees (normal 45), external rotation of 45 degrees (normal 60), and internal rotation of 30 degrees (normal 40).  The heel tap (assess for fracture or joint pathology), log roll (assesses for hip joint pathology), and straight leg raise ([SLR] assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests were negative.  The examiner recounted the findings of the X-rays and bone scan.  The assessment listed left femoral neck stress fracture, status post cannulated screw fixation.  The orthopedic surgeon opined “On clinical exam this is healed at this point.  There are no further surgical indications; however, should he return to basic training this patient is at increased risk for developing further stress fractures and possibly incurring a stress fracture of his right femoral neck.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (arthritis, degenerative) citing left femoral neck stress fracture, positive X-ray and bone scan, status post internal fixation with three cannulated Synthes screws, residual pain, risk of recurrent injury, and rated as degenerative arthritis without loss of joint motion.  The VA assigned a 0% rating under an analogous 5252 code (thigh, limitation of flexion of) based on the Service medical records and noting the CI failed to report for the scheduled VA C&P examination.  The VA cited left femoral neck stress fracture, status post cannulated screw fixation, and a noncompensable (0%) rating is assigned when the service connected disability is not disabling to the extent required by the rating criteria for a compensable evaluation.  While there was a history of left femoral neck stress fracture status post cannulated screw fixation, there was no femur fracture nonunion/malunion (5255) for consideration under the respective code.  There was no hip ankylosis (5250) or hip flail joint (5254) for consideration under the respective codes.  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.  The panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §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 left femoral neck stress fracture condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left femoral neck stress fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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 Femoral Neck Stress Fracture	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150907, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012495, 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,