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-2017-01990

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 13 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:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01990 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090629

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O-3, Judge Advocate, medically separated for “left hip pain” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested. 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 - 20090325	PROPOSED VARD – 20090313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Pain S/P Closed Reduction and Internal Fixation of Displaced …	5299-
5255	10%	Residuals, S/P, Left Hip Reduction and Internal Fixation of Displaced Femoral Neck Stress Fracture	5299-5255	10%	
20081008	
History of Amenorrhea	Cat II	Anorexia Nervosa, with Amenorrhea and Anemia	9520	0%	20081007	
History of Eating Disorder	Cat II					
History of Osteopenia	Cat II	Osteopenia	5237-5013	0%	20081008	
Pes Planus	Cat III	Bilateral Metatarsalgia …	5299-5279	10%	20091209	
Pelvic Strain	Cat III	See 5299-5255 above	
Anxiety Disorder, NOS	Cat III	Depressive Disorder, NOS; Anxiety Disorder, NOS	9499-9434	10%	20091208	
Depressive Disorder, NOS	Cat III					
Seasonal Allergic Rhinitis	Cat III	Seasonal Allergies	6599-6522	NSC	20081008	
Bilateral Knee Osteoarthritis	Cat III	Degenerative Arthritis, Bilateral Knees	5260-5010	10%	
20081008	
Bilateral Iliotibial Band Syndrome	Cat III					
History of Anemia, Resolved	Cat III	Anemia	7700	NSC	20081008	
History of Bilateral Feet Stress Fractures	Cat III	Residuals, S/P Left Foot Stress Fracture	See 5299-5279 above	20091209	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Left Hip Pain after Closed Reduction and Internal Fixation of Displaced, Delayed Diagnosed, Femoral Neck Stress Fracture. According to the service treatment record and MEB narrative summary (NARSUM), on 19 December 2007 the CI underwent a closed reduction and internal fixation to treat a displaced femoral neck fracture.

At the 8 October 2008 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported constant 4/10 left hip pain, which increased to 8/10 with weather, when walking over 0.25 miles, or sometimes for no specific reason. The examiner found a gait with a slight limp and although the CI brought a cane she walked without assistance. Posture was normal and she was able to able to walk on toes/heels without pain and perform partial squatting with knee pain. Strength was normal and there was no pain with hip range of motion (ROM) testing (as charted below).

The 28 January 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of left hip pain worse with activities of daily living such as walking and sitting. The CI reported occasional radicular symptoms to the lateral hip and knee. X-rays showed a healed femoral neck stress fracture with three retained cannulated screws. Physical examination showed a normal gait.  There was normal left leg strength with painful ROM as charted below.

The ROM examinations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Hip (Thigh) ROM (Degrees)	VA C&P ~8 Mo. Pre-Sep	MEB ~5 Mo. Pre-Sep	
Flexion (125 Normal)	125	110	
Extension (30)	20	20	
External Rotation (60)	45	45	
Abduction (45)	45	45	
Comment	Painful squatting	Painful motion	
§4.71a Rating	10%	10%	

The panel directed attention to its rating recommendation based on the above evidence. This was an integrated DES (Disability Evaluation System) case and the PEB incorporated the DVA ratings regarding their unfitting conditions.

The PEB rated the left hip condition 10%, analogously coded 5299-5255 (femur, impairment) adopting the proposed VA 10% rating. The PEB listed History of: Amenorrhea, Eating Disorder, and Osteopenia conditions as related diagnoses (Category II) contributing to the disability in this case. The VA proposed rating for the left hip condition was 10%, analogously coded 5299-5255, based on the C&P examination, citing malunion of the femur with slight hip disability, with the same rating and coding on the 23 February 2010 original VARD.

The VA proposed ratings for the additional Category II conditions were “anorexia nervosa (eating disorder), with amenorrhea and anemia,” at 0% coded 9520 (anorexia nervosa), and osteopenia, at 0% coded 5237-5013 (lumbosacral strain – osteoporosis, with joint manifestations). The subsequent original VARD changed the DES proposed diagnoses and ratings to amenorrhea not service-connected (NSC), coded 7699-7629 (endometriosis), anemia, NSC, coded 7700 (anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia), and osteopenia, NSC, coded 5237-5013.

The panel considered that the PEB adopted the same VA DES disability ratings for the unfitting left hip and the Category II conditions, and that there was no VA rating increase in those conditions on the subsequent original VARD. The VA ratings were adjudged as reasonable and therefore, there was insufficient evidence for any rating(s) in addition to that awarded by the PEB. 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 (including the Category II conditions).

Contended PEB Conditions: Pes Planus, Pelvic Strain, Anxiety Disorder, Depressive Disorder, Seasonal Allergic Rhinitis, Bilateral Knee Osteoarthritis, Bilateral Iliotibial Band Syndrome, History of Anemia, and History of Bilateral Feet Stress Fractures. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Although the NAVMED 6100/1 (MEB cover sheet) listed diagnoses that likely overlapped the contended PEB Category III conditions, none of the conditions were noted on limited duty forms, or implicated in the non-medical assessment which specified only complications from the unfitting hip condition. There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left hip condition (with Category II conditions) and IAW VASRD §4.71a (§4.116 and §4.130), the panel recommends no change in the PEB adjudication. In the matter of the contended pes planus, pelvic strain, anxiety disorder, depressive disorder, seasonal allergic rhinitis, bilateral knee osteoarthritis, bilateral iliotibial band syndrome, history of anemia and history of bilateral feet stress fractures conditions, the panel recommends no change from the PEB determinations 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.