RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00625
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Military Police, medically separated for “right femoral neck stress fracture” 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 - 20031124	VARD - 20040831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt Femoral Neck Stress Fracture	5099-5003	0%	Rt Femoral Neck Stress Fracture	5255	10%	20040517	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Femur.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hip condition began without a specific injury in May 2003.  An X-ray of the pelvis on 12 May 2003 was normal.  Radiographic studies showed a hip strain with no remarkable findings.  The CI was treated with medication, crutches, and duty restrictions, but her pain continued.  A second X-ray revealed a healing inferior pubic stress fracture on the left side for which the CI was asymptomatic.  A bone scan the next day on 30 July 2003 showed stress fractures of the left pubic ramus (part of the pelvis), right femoral neck (part of the hip), as well as the left shin.  Overuse of the left ankle and foot was also noted.  A follow-up X-ray of the right hip on 16 October 2003 was normal.  It was noted that the CI continued to have pain despite 2 periods of light duty of 4 weeks each.  She was then referred for MEB.  

The 17 October 2003 MEB NARSUM examination, 3 months prior to separation, noted persistent complaints of pain in right groin area with ambulation and the continued use of crutches.  The physical examination showed an antalgic gait (abnormal due to pain) and a range of motion (ROM) of 120 degrees of flexion in the right hip; 70 degrees external rotation; 30 degrees internal rotation and 40 degrees of abduction.  There was no tenderness to palpation, but motion was painful at end range.  The X-rays were read as consistent with a healing compression side femoral neck stress fracture.  

At the VA Compensation and Pension (C&P) evaluation performed on 17 May 2004, 4 months after separation, the CI reported that she planned to start a job hanging clothes the next day.  The CI reported having a cane which she used for prolonged walking, but did not use it the day of the examination.  The physical examination showed a normal posture and gait.  The ROM showed 130 degrees of flexion (greater than the VA normal 125 degrees) and 30 degrees of extension (20 is normal).  Abduction was recorded as both 35 degrees and 55 degrees; one value is assumed to be adduction, but it is not clear which was which.  External rotation was 50 degrees (45 is normal).  Painful motion was not documented.  X-rays of the hips and pelvis were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right femur condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no loss of range of motion.  The VA rated the right femur condition 10%, coded 5255 (femur impairment), based on the C&P examination 4 months after separation, citing normal ROM of right hip with the exception of external rotation.  The panel observed that the examiner recorded a normal value of 60 degrees, but that the measured 55 degrees exceeded the VA normal value of 45 degrees.  Painful motion was recorded as not present, but the 10% rating was assigned for painful motion.  The panel could not explain this inconsistency.  The panel considered the evidence.  The limitation in motion was not compensable under 5251 (limitation in extension), 5252 (limitation in flexion), 5253 (impairment of the thigh), and 5003 (degenerative arthritis).  The panel considered the code 5255, but noted that the ROM was essentially normal and exceeded normal values in some planes.  Painful motion was not present on the VA examination although it had been at the NARSUM evaluation 3 months prior to separation.  The gait was normal on the VA examination, but painful at the NARSUM evaluation.  X-rays showed that the right femoral neck stress fracture had healed on the VA evaluation and were healing at the time of the NARSUM.  Healing from a stress fracture is the expected outcome and it is evident from the VA examination that this in fact had happened by the time of the VA examination.  The 0% rating adjudicated by the PEB is supported by the post-separation evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right femur condition.  

BOARD FINDINGS:  In the matter of the right femur condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10%, but elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 
AR20170016321, Mannon (Moore), Amanda M. 

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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