RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-01256
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060802

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

CI CONTENTION:   Her broken right hip has caused numerous medical issues such as hip pain, knee problems, deterioration of joint space, arthritis and drop foot syndrome.  Due to her condition she loses balance and falls.  She is not able to participate in sports, play with her daughter or pursue certain jobs because of her inability to bend, kneel or walk for long periods.  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 - 20060721	VARD - 20070117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture Right Femoral Neck 	5099 5003	10%	Right Hip Stress Fracture of Femoral Neck, Status Post Surgery; Bursitis	5299-5255	20%	20061205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Right Femoral Neck Stress Fracture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right hip condition began in March 2006 during basic training without specific trauma.  She reported a 2-week history of right hip pain and a bone scan on 23 March 2006 demonstrated a fracture of the right femoral neck.  She underwent percutaneous pinning of the fracture on 28 March 2006.  

The 18 May 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of persistent hip pain, which was steadily improving.  At the time of the physical examination, the CI was still using crutches post-operatively.  The surgical incision was well-healed, and right hip ROM showed flexion to 90 degrees, with pain past that.  External and internal rotation was symmetric with the opposite hip, but with painful motion as well.  The fracture line was no longer apparent on hip X-rays on 18 May 2006, with hardware in place and positioned well.  A CT scan on 24 November 2006 showed three surgical pins in place and no evidence of the previous fracture, arthritis, or other abnormality.  

At the 5 December 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported right hip and upper leg muscle pain.  She stated that her orthopedic specialist attributed the pain to the surgical hardware, which could not be removed for at least 10 months.  She described flare-ups 4 to 7 days a week, during which she could not bear weight on the hip.  She was being treated with steroid joint injections once every 3 months for bursitis at the site of the surgical screws, and was employed as a driver/delivery person for a glass company.  Physical examination showed a limp favoring the right leg, and ROM testing revealed flexion to 80 degrees and extension to 20 degrees, with painful motion.  The CI could toe out greater than 15 degrees and cross legs.  There was crepitus and guarding of movement of the right hip joint, and strength was graded 4/5 and limited by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hip condition 10%, analogously coded 5099-5003 (degenerative arthritis), with application of the US Army Physical Disability agency pain policy.  The VA rated the hip condition 20%, analogously coded 5299-5255 (impairment of femur), based on the C&P examination, citing malunion of the femur with moderate knee or hip disability.  Members agreed that code 5019 (bursitis) best characterized the hip condition with a 10% rating for painful, limited motion of a single major joint.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of thigh flexion, extension, or thigh impairment (5251, 5252, 5253); no evidence of hip ankyloses, flail hip joint, for a rating under the respective codes (5250, 5254); and no femur impairment due to nonunion or malunion (5255).  Post-operative hip X-rays showed healing of the fracture without abnormality.  There was therefore no rating higher than 10% under any applicable VASRD §4.71a code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and no change to the PEB’s coding choice is recommended.  After due deliberation, considering all 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 right hip condition.  

BOARD FINDINGS:  In the matter of the right hip 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

AR20190004042, XXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXX:

	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.