RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01454
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Ammunition Specialist, medically separated for “left hip femoral neck stress fracture” with a disability rating of 0%.  

CI CONTENTION:  He requested review of his left hip and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060315	VARD - 20061025	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Femoral Neck Stress Fracture	5099-5022	0%	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Hip Femoral Neck Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left hip condition began in February 2006 after physical training and road marches.  At the 21 February 2006 primary care clinic evaluation, he reported left hip pain, and the examiner noted the use of crutches and a severe antalgic gait, but normal posture and sensation intact.  

At the 22 February 2006 MEB NARSUM examination, 1 month prior to separation, the CI complained of intermittent left hip pain that required the use of crutches.  Physical examination showed a significant antalgic gait, but no tenderness in the left hip and groin areas, and minimal discomfort with internal or external rotation or flexion.  Goniometrically measured range of motion (ROM) was normal.  Left hip X-rays were unremarkable, but a bone scan showed increased uptake in the left femoral neck.  During the 1 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported a painful left hip stress fracture. Physical examination revealed an antalgic gait, tenderness and decreased ROM (not quantified).  

At the 23 March 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant left hip pain.  The provider noted a gait favoring the left leg, but no use of assistive devices.  Coordination, sensation, position sense and deep tendon reflexes were normal, and there was no muscle atrophy. Lower extremity strength was 4/5 due to pain.  Right hip ROM revealed flexion of 60 degrees (normal 125) and abduction of 35 degrees (normal 45); extension was not reported.  Hip X-rays were normal and the examiner stated “There is insufficient clinical evidence at present to warrant a diagnosis of any acute or chronic disorder or residuals thereof.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, analogously coded 5022 (periostitis), citing full ROM, no medication use, and the inability to complete basic training due to a lengthy recovery period.  The VA did not rate the left hip condition.  Members agreed there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), but no compensable ROM impairment under code 5251 (limitation of extension), 5252 (limitation of flexion) or 5253 (thigh, impairment).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left hip condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the left hip femoral neck stress fracture condition, the panel recommends a disability rating of 10%, coded 5299-5260 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	
Left Hip Femoral Stress Fracture	5299-5260	10%	

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  

AR20180011259, 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