RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01634
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3 , Trainee, medically separated for “bilateral femoral neck stress fractures” with a disability rating of 0%.  

CI CONTENTION:  His hips cause him pain daily.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20041101	VARD -  NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Femoral Neck Stress Fractures	5099-5003	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Femoral Neck Stress Fractures.    The PEB combined the right hip and left hip conditions under a single disability rating, coded analogously as 5099-5003 (degenerative arthritis) and rated 0%.  This 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 noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI developed bilateral displaced femoral neck stress fractures following a fall during basic training.  On 23 July 2004, he underwent bilateral hip closed reduction with internal screw fixation.  

During the 8 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported bilateral hip pain with activity and an inability to run.  Physical examination showed bilateral hip pain with range of motion (ROM) testing.  The MEB NARSUM examination, on the same day, revealed bilateral hip pain with FABER testing (flexion, abduction with external rotation), and ROM from 0-120 degrees (normal 125).    Hip X-rays showed healed bilateral femoral neck stress fractures with appropriate screw placement.  The right inferior femoral neck still showed a minimal lucency at the fracture site, but did appear to be near completely healed.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB rated the bundled bilateral hip stress fracture condition 0%, analogously coded as 5003, citing degenerative arthritis without significant loss of hip joint motion.  In this case, members noted that both hips had surgical repairs, were implicated by the NARSUM, were profiled, and were considered to fail retention standards.  Since undue speculation would be required to conclude that impairment from either hip would not have unacceptably interfered with military specialty performance, the panel agreed that each hip was reasonably justified as separately unfitting.    

Panel members noted there was no compensable limitation of hip motion under codes 5250 thru 5253 for either the left or right hip.  However, the MEB physical documented painful motion, and members adjudged that the left and right hip stress fractures therefore each warranted a 10% rating for sufficient evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45).  After considering several coding options, the panel agreed that coding analogous to 5255 (femur, impairment of; slight hip disability) most appropriately characterized the hip conditions.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends an unfitting left hip with a disability rating of 10%, and an unfitting right hip with a disability rating of 10%, each coded 5299-5255.  

BOARD FINDINGS:  In the matter of the bilateral femoral neck stress fractures, the panel recommends separately unfitting left and right hip conditions, with disability ratings of 10% each, and both coded 5299-5255 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Femoral Neck Stress Fracture, Left Hip	5299-5255	10%	
Bilateral Femoral Neck Stress Fracture, Right Hip	5299-5255	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161020, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011589 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,					      
Enclosure