DEPARTMENT  OF  THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-00637 

Subj: Ref:

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 4 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00637 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040615

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Marine, medically separated for “status post left proximal femur fracture” with a disability rating of 10%.

CI CONTENTION: Her condition remains painful and impacts daily activities. 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 -20040325	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Proximal Femur Fracture	5099-
5255	10%	

No VA Examination Proximate to Separation in Evidence	
Chronic Pain	Cat II		
Hip Flexor and Adductor Tendonitis	Cat II		
Status Post Intramedullary Nailing for a Proximal Femur Fracture	Cat II		
Left Patellofemoral Pain Syndrome	Cat II		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	
	
ANALYSIS SUMMARY:

Status Post Left Proximal Femur Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI had surgical repair of a left proximal femur fracture with intramedullary  nailing  on  15   June  2003.	Despite  aggressive  post-operative  rehabilitative measures, her left leg pain remained. An orthopedic clinical encounter dated 12 January 2004, 5

months prior to separation, noted painful motion and locking involving the left hip. The examiner noted only “self-therapy” performed by the CI. Range of motion (ROM) measurements were deferred.

The 29 January 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of continuous left hip pain that worsened with prolonged sitting and standing. Additionally, the CI endorsed "numbness" to the entire lower extremity with prolonged sitting. Her physical examination (PE) revealed left hip tenderness without effusion. ROM was flexion to 80 degrees (normal 125) extension and abduction were normal with no notation of painful motion. During the 23 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported no new or additional symptoms. The provider’s comments focused on the prior Medical Board dictation as described above. The diagnosis was listed as “chronic pain” left hip/femur.  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 left leg condition 10%, analogously coded 5299-5255 (femur, impairment). The PEB listed chronic pain, hip flexor and adductor tendonitis, left patellofemoral pain syndrome, and status post intramedullary nailing for a proximal femur fracture, as related diagnoses (Category II) contributing to the primary disability in this case. The panel deliberated and concluded that the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).

Although there was insufficient limitation of hip motion to support a minimum rating, panel members agreed that the PEB’s 10% rating was supported and appropriate for the presence of painful motion as evidenced in the 7-month post-operative follow-up with orthopedics. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left hip condition.

BOARD FINDINGS:  In the matter of the status post left proximal femur fracture 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. Therefore, the panel 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 20170213, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record