RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05612
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060602

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Interrogator-in-Training, medically separated for “chronic left hip pain secondary to stress fracture” with a disability rating of 20%.

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 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 - 20060330	VARD - 20070608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Hip Pain Secondary to Stress Fracture	5099-5003	20%	Residuals, Left Hip Stress Fracture	5255	10%	20061010	
Severe Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%	20061010	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Chronic Left Hip Pain Secondary to Stress Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left hip condition began in basic training during a ruck march in April 2004. She subsequently fell from a 10-foot wall and was diagnosed with a stress fracture of the left femur at the basilar neck just above the lesser trochanter. In November 2004 she underwent an open reduction and fixation, but despite non-weight bearing with use of a wheel chair, pain persisted. In October 2005 hardware was removed and a callus bone graft was injected into the lag screw and the cannulated screw hole to provide support during remodeling.

The 17 January 2006 MEB NARSUM examination, 5 months prior to separation, noted the complaint of left hip pain. Physical examination showed a surgical scar of the left hip. The CI used an assistive device for ambulation, and a duck walk was not attempted.

An orthopedic note dated 19 January 2006 indicated the CI had a deep ache in the thigh, but the preoperative pain had improved. Radiographs looked excellent. At a physical medicine and rehabilitation clinic visit on 15 February 2006, examination revealed tenderness over the left lateral upper leg, and range of motion (ROM) of the left hip was within normal limits except for end range tightness in internal and external rotation. Physical therapy ROM measurements (in degrees)  dated  8 March  2006 showed  flexion  112 (normal  125), extension  15  (normal   20),
abduction 15 (normal 45), adduction 18 (normal 25), and external rotation 32 (normal 45), all with painful motion except extension.

At the 10 October 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant left hip pain with occasional giving way, swelling, and stiffness. Physical examination showed her walking with a little limp favoring her left side and she used a cane. Left hip ROM showed flexion 0-125 degrees and abduction 0-35 degrees, both with pain.  With repetition flexion was 0-90 degrees and abduction 0-35 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left hip condition 20%, analogously coded 5099-5003 (degenerative arthritis), citing constant moderate pain. The VA rated the left hip condition 10%, coded 5255 (femur, impairment), based on the C&P examination, citing malunion of the femur with slight knee or hip disability.

There was no limitation of hip extension and flexion (codes 5251 and 5252) or thigh impairment (code 5253) nor was there any hip ankylosis (code 5250) or a flail joint of the hip (code 5254). The panel did consider whether code 5255 (femur impairment) or analogous code 5299-5255 was applicable to support a higher rating than 10%; however, the CI’s stress fracture of the femoral neck was surgically repaired and had healed prior to separation, but the CI still had pain and used an assistive device at the NARSUM examination and a cane at the VA examination, 4 months after separation. Therefore, the panel determined the disability at the time of separation approached a 20% rating, and no higher, using analogous code 5299-5255 for a moderate hip disability IAW VASRD §4.20 (analogous ratings) rather than code 5099-5003 used by the PEB. However, since the ratings are concordant irrespective of the code, no change in the rating is warranted. 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 chronic left hip pain secondary to stress fracture condition.

Contended PEB Condition: Severe Pes Planus. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the left hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended pes planus condition, the panel agrees it cannot recommend it for additional disability rating. 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.

ARXXXXXXXXXXX

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