RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02525 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Basic Marine, medically separated for “healing right displaced femoral neck stress fracture; status post [s/p] open reduction and pinning” with a disability rating of 10%.

CI CONTENTION: Review all conditions. 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 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 - 20060811	VARD - 20070206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Healing Right Displaced Femoral
Neck Stress Fracture; S/P Open Reduction and Pinning	5299-5255	10%	Right Displaced Femoral
Neck Stress Fracture, S/P Open Reduction and Pinning	5255	10%*	20060815	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%*	
*VA increased the right hip rating to 20% effective 20070319, based on examination of 20070618.

ANALYSIS SUMMARY:

Right Displaced Femoral Neck Stress Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a displaced right femoral neck stress fracture during recruit training. He underwent open reduction and capsular release of the hip with placement of three screws in the femoral neck in May 2006. The 18 July 2006 MEB NARSUM examination, 1 month prior to separation, documented complaints of right hip pain and weakness. The examiner noted the CI was walking with a single crutch with 50% weightbearing; despite instructions for non-weightbearing. There was mild right hip pain with motion and resistance, and measured range of motion (ROM), in degrees, revealed: flexion to 120 (normal 125), without pain, internal rotation to 35 (normal 40), with pain past 20, external rotation to 45 (normal 60), and abduction to 45 (normal), with mild pain at the extremes. An X-ray showed some healing of the fracture, but a still evident fracture line. The screws were in place and well- aligned, with no loosening of the hardware. The examiner noted increased concern with the CI’s

non-compliance of weight bearing instructions, stating he was at very high risk (25-30%) for nonunion and eventual hardware failure.

At the 15 August 2006 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported right hip pain, numbness, weakness, flares and continued use of a crutch. Physical examination showed a normal gait and well-healed surgical scars with numbness. There was right hip tenderness but no redness, swelling, or deformities. Right hip ROM measurements, in degrees, showed: flexion to 100, extension to 20 (normal 30), adduction to 25, abduction to 25, external rotation to 40 and internal rotation to 40 (normal). There was no pain on motion or additional limitation following repetitive use. During the 18 June 2007 C&P examination, 10 months after separation, the CI reported right femoral neck pain, stiffness, giving way, weakness and locking. The examiner documented numbness around well-healed surgical scars, and gait instability with mild, right-sided weakness and antalgia. The CI could not perform single limb support or toe walking on the right without imbalance, but heel walking was preserved bilaterally. Measured right hip ROM, in degrees, showed flexion to 70, extension to 30, adduction to 5, abduction to 15, external rotation to 30 and internal rotation of 10. There was painful motion, with increased pain on repetition, and muscle atrophy, decreased tone and bulk of the right quadriceps lateralis.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 10%, analogously coded 5299-5255 (femur, impairment of). The VA also initially rated the right hip condition 10%, coded 5255, based on the August 2006 C&P examination, and later increased the rating to 20%, effective 19 March 2007, based on the June 2007 C&P examination, citing reduced ROM. Panel members noted that the NARSUM and initial VA examinations were performed within 3 months of the right hip surgery and X-rays indicated incomplete healing with history indicating the CI was still using a crutch for ambulation. There was no compensable limitation of hip motion under codes 5250-5253, and although the pre- separation examinations documented painful motion and/or mild hip disability with sufficient functional loss (based on §4.59, §4.40 and §4.45) to support a 10% rating, the CI’s high-risk injury/surgery was still healing at that time, and not considered stable by the NARSUM examiner. The post-separation VA examination was within the 12 months specified in DoDI 6040.44, was further from surgery (to allow both healing and scarring), and showed clear evidence of right hip painful motion, antalgic and unstable gait as well as muscle atrophy and weakness which best supported a 20% moderate hip disability. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right hip condition, coded 5299-5255.

BOARD FINDINGS: In the matter of the right hip condition, the panel recommends a disability rating of 20%, coded 5299-5255 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	
Healing Right Displaced Femoral Neck Stress Fracture;
Status Post Open Reduction and Pinning	5299-5255	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 30 Jan 20
(b)	

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

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEE) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.