RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05537
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic pain, due to excessive callous formation after distal one third femur fracture” 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’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 – 20041207 	VARD - 20050910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, due to Excessive Callous Formation after Distal one-third Femur Fracture	5255	10%	Femur Fracture, Left Thigh	5299-5255	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Left Femur Fracture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgical repair of his left femur with intramedullary nail after a motor vehicle accident in November 1997.  The nail was removed in 1998.  In February 2000, he sustained a femoral neck fracture and underwent closed reduction with three percutaneous screws.  His left thigh became symptomatic in October 2003.  X-rays revealed a bony callous formation at the distal third of his left femur extending into the soft tissues of his femur.  An MRI confirmed the bony callous formation.    

The 13 September 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of pain with going down stairs and walking down uneven terrain, especially down hills.  Physical examination of the left leg showed flexion of 125 degrees (normal) and abduction of 125 degrees (normal 45).  There was tenderness above the distal third of his femur with associated soft tissue mass.  There was no erythema or anything that would suggest infection at the site of the fracture.  There was no VA examination related to the left leg condition proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left femur condition 10%, coded 5255 (femur, impairment of), citing slight hip disability.  The VA also rated the left femur condition 10%, analogously coded 5299-5255, based on the STR.  Applicable codes include 5255, 5251 (limitation of extension), 5252 (limitation of flexion) and 5253 (thigh impairment).  A 20% rating under any of the applicable codes requires demonstration of moderate knee or hip disability or significant limitation of flexion, extension and abduction.  The panel found no evidence to support a higher rating under any of the applicable codes for his condition.  However, there was evidence of painful motion with functional loss supporting the PEB’s rating of 10% for slight hip disability based on §4.59, §4.40 and §4.45.  After due deliberation, considering all of 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 femur condition.  

BOARD FINDINGS:  In the matter of the left femur condition and IAW VASRD §4.71a, the panel unanimously 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 20170719, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007422, 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