RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03619
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “femur, impairment of right” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20080513	VARD - 20090116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Femur, Impairment of Right	5255	10%	Status Post IM Nailing of Right Femur Diaphyseal Fracture…	5299-5255	10%	20081122	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Right Femur Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his right femur on 16 May 2007 after a fall down stairs, and underwent open reduction and internal fixation surgery with intramedullary rod placement on 17 May 2007.  On 4 June 2007 and 9 July 2007, X-rays demonstrated excellent position and alignment of the fracture with new bone growth and calcification. The CI did well with postoperative physical therapy, but on 8 January 2008, he reported increasing right femur and knee pain over the prior 2 months after starting full physical training, which included running.  On examination, he had deep pain of the right femur proximally and distally.  At a clinic appointment on 27 February 2008, the CI had full range of motion (ROM) and strength of the right lower extremity, hip, knee and ankle, and a well-healed lateral hip surgical scar.  There was no apparent leg length discrepancy and his gait was non-antalgic.  Leg X-rays showed an intramedullary rod and screw spanning a healed mid diaphyseal fracture with no evidence of complications.  

The 28 March 2008 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of constant right thigh pain, rated at 4/10, which increased with weather changes, walking, sitting and impact activities.  Physical examination showed a well-healed scar without erythema or tenderness.  There was no pain with right hip axial loading, internal and external rotation, or with thigh squeezes throughout the entire length of the femur.  There was no tenderness of the thigh, hip or knees, and no laxity or instability of the knees or evidence of a meniscal tear (negative McMurray’s testing).   Muscle strength was 5/5 bilaterally and the extremities were neurovascularly intact distally.  Hip ROM was measured by physical therapy on 29 February 2008 using a goniometer.  Right hip flexion was to 115 degrees (normal 125), extension to 16 degrees (normal 20), and abduction to 30 degrees (normal 45).  Left hip flexion was to 118 degrees and extension to 20 degrees.  Mild pain was noted with passive ROM and mild weakness was noted with right hip extension.  Right knee flexion was to 148 degrees (normal 140), and extension to +5 degrees (normal 0), indicating hyperextension; and left knee flexion was to 149 degrees and extension to +5 degrees.  

At the 22 November 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported pain and moderate daily flare-ups precipitated by standing, jogging, carrying heavy objects or walking.  Physical examination showed a normal gait and right hip flexion from 0 to 125 degrees, extension from 0 to 25 degrees, and abduction from 0 to 35 degrees.  The CI could cross his right leg over his left leg and could toe out greater than 15 degrees.  Leg X-rays revealed a rod transfixing a healing/healed mid femoral diaphyseal fracture in anatomic alignment without abnormal angulation.  The knee and hip joints were maintained with no acute osseous abnormality.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right femur fracture condition 10%, coded 5255 (femur, impairment of), citing slight hip disability and non-antalgic gait.  The VA also rated the right femur fracture condition 10%, coded 5299-5255, based on the C&P examination, citing femur malunion with slight knee or hip disability.  Members noted the CI had a satisfactory healing process, confirmed by X-rays, until he began running.  Therefore, use of code 5255 in the absence of nonunion, false joint, or moderate knee or hip disability precludes a higher rating than 10%.  Furthermore, there was no hip ankylosis (5250), thigh limitation of flexion (5252), thigh impairment (5243), or hip flail joint (5254) to warrant a rating higher than 10%; nor was there limitation of extension (5251) to even meet criteria for a 10% rating.  After due deliberation, considering all of 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 femur fracture condition.  

BOARD FINDINGS:  In the matter of the right femur fracture 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180010015, 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