RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01142
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20091103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “femur impairment” with a disability rating of 10%.   

CI CONTENTION:  The CI submitted a lengthy contention that her condition has worsened and requested a higher rating.  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 - 20091007	VARD - 20100506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Femur Impairment	5299-5255	10%	Right Hip Condition with Pelvic Condition	5299-5252	NSC	STR	
Lower Back Pain	Not Unfitting	Chronic Low Back Pain	5237	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Femur Impairment (Chronic Right Hip Pain).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right hip condition began in basic training during a physical training test.  Bone scan performed on 16 March 2009 showed “minimal” uptake in the upper medial femurs consistent with thigh splints.   Following convalescent leave, the CI was not improved.  An MRI of the hips performed on 12 May 2009 showed right, mid-femoral neck compressive stress fracture.  Right hip X-rays on 6 August 2009 showed a healing right femoral neck stress fracture.  The 10 September 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic right hip pain aggravated by weight bearing activity.  Physical examination showed a slow, but otherwise normal, gait.  There was tenderness over the right anterior hip/thigh (femoral triangle).  There was no guarding, muscle spasm, or ligamentous laxity.  Right hip range of motion was flexion 115 degrees (normal 125), extension 5 degrees (normal 20), and abduction 26 degrees (normal 45), with painful motion noted.  The CI was able to toe out more than 20 degrees and cross her legs without difficulty.  Strength and sensation were normal.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the femur impairment condition 10%, coded 5299-5255 (analogous to femur impairment), citing analogous to malunion of the hip with slight hip disability.  The panel reviewed to see if a higher rating was supported with any applicable VASRD code.  The CI was not using any assistive device and had a normal gait and her disability due to the stress fracture was anticipated to improve with continued healing.  The panel agreed the evidence did not support characterizing the femur impairment as moderate for a higher rating under 5255.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of thigh flexion or extension or thigh impairment (5251, 5252, and 5253).  There was no evidence of hip ankyloses or flail hip joint (5250, 5254,) for a rating under the respective codes.  After due deliberation, considering all of 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 femur impairment condition.  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the femur impairment condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended lower back condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004929, 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