RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  MARINE CORPS 
SEPARATION DATE:  20051015 

 
NAME:  XXXXXX                 
CASE NUMBER:  PD1100842                                                       
BOARD DATE:  20121017 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  Reserve  CPL/E-5  (0311/Rifleman),  medically  separated  for 
heterotopic ossification (abnormal bone formation) of the right hip and avascular necrosis of 
the left wrist scaphoid.  The hip condition arose as a consequence of a femur fracture in 2004 
and  the  left  wrist  scaphoid  condition  from  a  fall  in  2003.    Neither  condition  responded 
adequately  to  operative  or  rehabilitative  treatment,  nor  was  he  able  to  meet  the  physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  
He was placed on medical hold status and referred for a Medical Evaluation Board (MEB).  The 
MEB submission was not available for review.  The Physical Evaluation Board (PEB) adjudicated 
the right  hip  heterotopic  ossification  and  left  wrist  scaphoid  avascular necrosis  conditions  as 
unfitting, rated 10% respectively, with application of the Veteran’s Affairs Schedule for Rating 
Disabilities  (VASRD).    Right  femur  fracture  and  healed  right  femur  fracture  were  included  as 
related Category II diagnoses.  Additionally, knee pain and chondromalacia patella were rated 
as  Category  III  (conditions  that  are  not  separately  unfitting  and  do  not  contribute  to  the 
unfitting  conditions).    The  CI  made  no  appeals  and  was  medically  separated  with  a  20% 
disability rating. 
 
 
CI CONTENTION:  “The medical reasons which I was found unfit for duty continue to exist and 
worsen.  Other injuries were also not taken into consideration when going through my MEB 
Board and medically discharged from the military.  The Veterans Administration rated me with 
a higher rating at 60% and is currently reviewing my records to increase.  The injuries continue 
to  exist  and  continue  to  make  me  do  routine  appointments  with  the  VA  system  and  private 
healthcare.  The injuries sustained while in the service continue to make my daily living very 
difficult  and  continues  to  limit  my  employment  opportunities.    I  continue  to  seek  medical 
attention for the daily pain; I ask for my review to be highly considered.  Thank you.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all  cases.    The  knee  condition  requested  for  consideration  and  the  unfitting  right  hip,  femur 
fracture  and  left  wrist  conditions  meet  the  criteria  prescribed  in  DoDI  6040.44  for  Board 
purview; and, are addressed below.  The remaining conditions rated by the VA at separation are 
not within the Board’s purview.  Any conditions or contention not requested in this application, 
or  otherwise  outside  the  Board’s  defined  scope  of  review,  remain  eligible  for  future 
consideration by the Board for Correction of Naval Records. 
 
 
 
 
 
 

RATING COMPARISON: 

Service IPEB – Dated 20050422 

Condition 

Heterotopic Ossification, 
Right Hip 
Right Femur Fracture 
Healed Right Femur Fracture 
Avascular Necrosis Lt Wrist 
Knee Pain 
Chondromalacia Patella 

Code 

5299-5255 

Rating 
10% 

Category 2 
Category 2 

5099-5215-

5003 

Category III 
Category III 

 
VA (~1 Mo. After Separation) – All Effective Date 20051016 

Condition 

Code 

Rating 

Exam 

Right Femur Fracture 
Residuals 

7121-5252 

10% 

20051104 

10% 

Residual Left Wrist Fracture 

5215 

Rt. Patellofemoral Syndrome 
Scar Rt. Greater Trochanter 
Back Strain 
Tinnitus 

5014-5260 

7804 
5237 
6260 

0% x 2/Not Service Connected x3 
Combined:  50%* 

10% 

10% 
10% 
10% 
10% 

20051104 

20051104 
20051104 
20051104 
20051104 
20051104 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

*Rating decision 20080111 added PTSD 9411 at 30%, effective 20070501, based on later outpatient records; combined 60%.   
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impact  that  his  service-incurred  condition  has  had  on  his  current 
earning ability and quality of life.  It is a fact, however, that the Disability Evaluation System 
(DES)  has  neither  the  role  nor  the  authority  to  compensate  members  for  anticipated  future 
severity or potential complications of conditions resulting in medical separation.  This role and 
authority  is  granted  by  Congress  to  the  Department  of  Veterans’  Affairs  (DVA).    The  Board 
utilizes  DVA  evidence  proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI 
6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The 
Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES 
fitness  determinations  and  rating  decisions  for  disability  at  the  time  of  separation.    Post-
separation  evidence  therefore  is  probative  only  to  the  extent  that  it  reasonably  reflects  the 
disability and fitness implications at the time of separation.  With regard to the CI’s assertion 
that other injuries were not taken in to consideration by the MEB, the Board also must note for 
the record that it has neither the jurisdiction nor authority to scrutinize or render opinions in 
reference to suspected service improprieties in the disposition of a case. 
 
Right Hip Condition.  A motor vehicle accident in January 2004 caused a right femur fracture 
that was surgically treated with intramedullary nailing.  Complete healing of the femur fracture 
during the post-operative course was noted, but heterotopic ossification developed in the soft 
tissues of the right hip near the head of the femoral nail.  Right thigh and hip pain persisted.  
There  were  three  goniometric  range-of-motion  (ROM)  evaluations 
in  evidence,  with 
documentation of additional ratable criteria, which the Board weighed in arriving at its rating 
recommendation; as summarized in the charts below.   
 
 
 
 
 
 
 
 
 
 
 
 

   2                                                           PD1100842 
 

MEB ~ 12 Mos. Pre-Sep 

PT ~9 Mos. Pre-Sep 

VA C&P ~ 1 Mo. After-Sep 

115 
0 
25 

45 (50) 

35 

Non-antalgic gait.  

100 
8 
25 
40 

Not tested 

Abnormal gait, 

trochanter. 

10% 

motion 
10% 

95 
30 
40 
45 
20 

Slightly antalgic gait, pain with 
motion, +tenderness over the 

greater trochanter. 

10% 

Right Hip (Thigh) ROM – 

(in degrees) 
Flexion (0-125) 
Extension (10-20) 

External Rotation (0-45) 

Abduction (0-45) 
Adduction (0-45) 

§4.71a Rating 

Comment 

+tenderness over greater 

+tenderness, pain with 

 
The narrative summary (NARSUM) exam performed on 30 September 2004 reported that the CI 
could not run, carry heavy objects, climb or crawl.  Exam revealed tenderness over the greater 
trochanter of the right hip, but not of the mid-shaft of the femur.  There was no pain when 
physical  stress  was  applied  to  the  fracture  site.    Marked  improvement  of  previous  vastus 
medialis  muscle  atrophy  was  noted.    X-rays  showed  a  well-healed  femur  fracture  and 
heterotopic ossification in the soft tissue area of the right hip.  At the VA Compensation and 
Pension  (C&P)  exam  performed  on  4  November  2005  (3  weeks  after  separation),  the  CI 
reported right hip pain in the area of the surgical screws from prolonged sitting or walking.  The 
pain was only present with activities.  Examination revealed greater trochanter tenderness, but 
no thigh tenderness. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  assigned  a  10%  rating  under  the  5255  code  (impairment  of  femur),  judging  there  was 
“slight” hip disability.  The VA gave a 10% rating for painful motion under the 7121-5252 code 
(post-phlebitic  syndrome,  limitation  of  flexion).    The  Board  agreed  that  a  10%  rating  was 
justified under 5251 (compensable limitation of extension at time of MEB exam), or for pain 
with use (§4.40) or painful motion (§4.59).  The Board also considered whether “moderate knee 
or hip disability” under the 5255 code was an accurate descriptor of the clinical picture, but 
concluded  that  the  “slight”  disability  assessment  made  by  the  PEB  was  appropriate.    Healed 
right femur fracture was designated as a Category II condition and is appropriately subsumed 
under the right hip condition already discussed above.  After due deliberation, considering all of 
the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there 
was  insufficient  cause  to  recommend  a  change  in  the  PEB  adjudication  for  the  right  hip 
condition. 
 
Left Wrist Condition.  The service treatment record (STR) indicates that a left scaphoid bone 
fracture  occurred  on  29  May  2003  while  deployed.    After  treatment  with  a  cast,  the  CI 
continued to experience pain in the left wrist.  At a primary care clinic visit on 25 October 2004 
(one  year  prior  to  separation)  the  CI  complained  of  recurring  pain  that  was  worsening.    The 
provider indicated that planned wrist surgery in January 2004 was pre-empted because of the 
MVA.    The  NARSUM  examiner  was  silent  regarding  the  wrist  condition.    The  VA  examiner 
reported that the right hand dominant CI underwent surgery on 6 July 2005 (2 months after the 
PEB,  3  months  prior  to  separation)  for  avascular  necrosis  of  the  left  scaphoid  bone,  but 
continued  to  complain  of  chronic  stiffness  and  pain.    He  did  not  use  a  splint.    Decreased 
strength caused reduced endurance, but did not result in dropping items.  Exam revealed wrist 
tenderness.    ROM  measurements  were  dorsiflexion  of  70  degrees  (normal  to  70  degrees), 
palmar flexion of 30 degrees (normal to 80 degrees), ulnar deviation of 20 degrees (normal to 
45  degrees)  and  radial  deviation  of  30  degrees  (normal  to  20  degrees).    Painful  motion  was 
present  and  increased  discomfort  with  repetitive  testing  was  also  noted.    No  atrophy  of  the 
palm muscles was present.  Objective testing showed 30 pounds of grip strength on the left 

   3                                                           PD1100842 
 

compared  to  115  pounds  on  the  right.    X-rays  revealed  post  surgical  changes  and  mild 
degenerative changes of the hip joint. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  assigned  a  10%  rating  under  an  analogous  5215-5003  code  (limitation  of  wrist  motion, 
degenerative arthritis).  The VA’s 10% rating was assigned for painful motion since limitation of 
motion was non-compensable.  Under the 5215 code, 10% is the highest possible rating, while a 
higher rating under 5214 requires ankylosis of the wrist.  Board members therefore agreed that 
a  pathway  to  a higher  rating  was not  present.   After  due deliberation, considering  all  of  the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was 
insufficient cause to recommend a change in the PEB adjudication for the left wrist condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  knee  pain  and  chondromalacia  patella.    The  Board’s  first  charge  with  respect  to  these 
conditions  is  an  assessment  of  the  appropriateness  of  the  PEB’s  fitness  adjudications.    The 
Board’s  threshold  for  countering  fitness  determinations  is  higher  than  the  VASRD  §4.3 
(reasonable doubt) standard used for its rating recommendations, but remains adherent to the 
DoDI  6040.44  “fair  and  equitable”  standard.    These  conditions  did  not  carry  attached  duty 
limitations, were not implicated in the non-medical assessment (NMA), and were not judged to 
fail  retention  standards.    They  were  reviewed  by  the  action  officer  and  considered  by  the 
Board.    There  was  no  indication  from  the  record  that  either  of these  conditions  significantly 
interfered with satisfactory duty performance.  After due deliberation in consideration of the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB fitness determination for the any of the contended conditions; 
and, therefore, no additional disability ratings can be recommended. 
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were  exercised.    In  the  matter  of  the  right  hip  heterotopic  ossification  condition  and  IAW 
VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the 
matter of the left wrist scaphoid avascular necrosis condition and IAW VASRD §4.71a, the Board 
unanimously recommends no change in the PEB adjudication.  In the matter of the contended 
knee pain and chondromalacia patella and conditions, the Board unanimously recommends no 
change from the PEB determinations as not unfitting.  There were no other conditions within 
the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

UNFITTING CONDITION 

Right Hip Heterotopic Ossification 
Avascular Necrosis Left Wrist Scaphoid 

 
 
 
 
 
 

VASRD CODE 
5299-5255 

5099-5215-5003 

COMBINED 

RATING 

10% 
10% 
20% 

   4                                                           PD1100842 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110812, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXX 
           President 
           Physical Disability Board of Review 

   5                                                           PD1100842 
 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL 

                                  OF REVIEW BOARDS  
 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

 

 
 
 
 
 

     

Ref:  (a) DoDI 6040.44 
 

(b) CORB ltr dtd 7 Nov 12 

 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR 
that the following individual’s records not be corrected to reflect a change in either characterization 
of separation or in the disability rating previously assigned by the Department of the Navy’s 
Physical Evaluation Board: 
 
                  -    former USN  
-    former USN  
-    former USMC 
-    former USN   
-    former USMC 
-    former USMC 
-    former USMC 
-    former USN  

 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  
  Assistant General Counsel 
  (Manpower & Reserve Affairs) 

   6                                                           PD1100842