AR20170014676, 
XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00061
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “bilateral femoral shaft stress fractures” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 – 20050810	VARD - 20060209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Femoral Shaft Stress Fractures	5099-5003	0%	Left Femoral Shaft Stress Fracture	5255	0%	STR	
			Right Femoral Shaft Stress Fracture	5255	0%	STR	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Femoral Shaft Stress Fractures.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral femoral shaft stress fractures condition began in April 2005 without specific injury during basic training.  Radiographic imagining (X-rays) taken in June 2005 demonstrated bilateral-healing proximal mid-femoral shaft stress fractures.

During the 28 July 2005 MEB NARSUM examination, 1 month prior to separation, the CI complained of bilateral thigh pain.  Current medications was noted as “none.”  Physical examination of the bilateral hip and pelvis recorded “full range of motion” and absence of localized tenderness; painful motion was not documented.  Gait, all muscle groups strength, bilateral knee and neurological examinations were normal.  The examiner expected the CI to make a “full recovery from these injuries.”  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “bilateral femoral shaft stress fractures” condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy which rated the pain as mild and intermittent.  The VA rated both left and right femoral shaft stress fracture condition 0% each, coded 5255 (femur, impairment), based on the STR.

The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel also noted that “bundling,” the combining of 2 or more major joints, may be permissible under the VASRD 5003 rating requirements, and this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.

Panel members considered the objective findings and associated disability of each thigh.  Bilateral femur stress future was profiled L3, there was no commander statement as the CI was in basic training; however, both the MEB NARSUM and MEB report judged the bilateral condition to fail retention standards.  The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the bundled right and left femur stress fracture conditions were reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting right and left femur stress fracture conditions at the time of separation.

There was no radiographic evidence of arthritic changes, no limitation of motion, or painful motion documented for either extremity to support a 10% rating under code 5003 or IAW VASRD §4.59 (painful motion).  There was no associated knee or hip malunion or fracture to support a rating under code 5255 (femur, impairment).  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 bilateral femoral shaft stress fractures condition.

BOARD FINDINGS:  In the matter of the bilateral femoral shaft stress fractures condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160204, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record