RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02490
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Mortarman, medically separated for “open left femur fracture” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20041202	VARD - 20060315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Open Left Femur Fracture	5299-5255	10%	Torn ACL, Shattered Femur, Rod in Left Leg	5260	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Left Femur Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left femur condition began after sustaining a gunshot wound to his left thigh in October 2002.  The 18 March 2004 MEB NARSUM examination, 11 months prior to separation, noted complaints of ongoing pain and decreased sensation near the wound of the CI’s left thigh.  Physical examination showed the range of motion (ROM) in the left knee was 0 to 125 degrees (normal 140). Radiographic evidence “showed broken interlocking screws at the distal part of the intramedullary nail suggesting that the CI was bearing weight on the femur which was not yet able to support weight.”  Additionally, the examiner cited the CI would “continue to ambulate with crutches and toe touch weight-bearing” and would be “unable to run or participate in heavy impact sports without significant pain.”  X-ray evaluation of the left femur dated 17 June 2004, 8 months prior to separation, noted new bone formation, soft tissue calcification, and that the intramedullary pin was in place and there was an old femoral fracture.  

At a June 2004 VA Compensation and Pension (C&P) evaluation, performed 8 months prior to separation, the CI reported chronic left hip and knee pain and incoordination.  He stated that he was not able to stand greater than 10 minutes or perform prolonged running, bending or heavy lifting activities.  He took Motrin as needed for pain.  The physical examination showed the CI preferentially bore weight on the right leg, but the gait was “relatively normal.”  There was slightly lowered endurance of the left thigh as compared to the right due to pain.  There was left hip tenderness and limitation of motion due to pain fatigue and lack of endurance.  Left hip ROM measurements were recorded as 110 degrees of flexion (normal 125), extension to 25 degrees (normal 30) and abduction to 25 degrees (normal 45).  The left knee demonstrated flexion to 125 degrees (normal 140) with limitation due to pain, fatigue, and lack of endurance.  The examiner noted the major functional impact was pain.  There was mildly decreased sensation on the medial and lateral aspects of the left thigh.  The right leg was 2 centimeters longer than the left.  The examiner noted the CI did not use any assistive devices for ambulation.  Coordination was normal.  There was 5/5 muscle strength of the left lower extremity.  There was no evidence of femur malunion, nonunion or deformities.  There was no VA Rating Decision (VARD) from this C&P examination in evidence. 

At a 7 September 2004 orthopedic evaluation, 5 months prior to separation, the examiner noted that the CI was doing well with knee ROM of 0-140 degrees.  The examiner assessed that the CI was stable and recommended increased activity as tolerated.  The NARSUM addendum based on the aforementioned orthopedic examination documented that the CI walked without pain, but he was unable to run or participate in heavy impact sports without significant pain.  At the 14 October 2004 MEB examination, 4 months prior to separation, the CI reported left leg pain, a permanent limp, and loss of a few inches on left leg length.  The examiner noted that the CI ambulated with a limp and had pain with prolonged standing, walking and weight-bearing.  The CI did not report to the scheduled 22 February 2006 VA C&P evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left femur condition 10%, analogously coded 5299-5255 (femur impairment with slight hip or knee disability).  The VA did not service connect the left femur condition coded 5260 (leg limitation of flexion) based on the STR and citing failure to report for VA examination on 22 February 2006. The Board noted that the CI’s primary complaint was left knee and hip pain secondary to the left femur fracture.  The STR and the 2004 C&P (the VA records most proximate to separation), noted the condition was stable and that there was a “relatively normal gait.”  Board members agreed the evidence supports a 10% rating for left femur impairment with slight hip and knee disability.  The Board considered separately rating the left hip and knee for painful motion at 10%; however the evidence did not support that each joint rose to the level of separately unfitting for separate ratings.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the open left femur fracture condition.

BOARD FINDINGS:  In the matter of the open left femur fracture and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends 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 20150930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 26 Apr 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXXX
	     				  	 Assistant General Counsel
						                				(Manpower & Reserve Affairs)