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AF | PDBR | CY2012 | PD-2012-01951
Original file (PD-2012-01951.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX   CASE: PD-2012-01951    
BRANCH OF SERVICE: MARINE CORPS         BOARD DATE: 20140131
SEPARATION DATE: 20031130                


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3(0300/Trainee) medically separated for right femoral neck stress fracture. The CI injured his hip in recruit training and was not able to complete basic training. The hip condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was placed in the Basic Marine Platoon and referred for a Medical Evaluation Board (MEB). The hip condition, characterized as “healing right femoral neck stress [fracture],” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “healing right femoral neck stress [fracture]” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “The 10% rating originally assigned to my disability seems to be low for an injury that affected and continue to affect multiple parts of my life. I have read about and spoken to others with the same injury that have received a significantly higher rating than mine. If my injury is sever [sic] enough for me not to be given to reenlistment code of RE-3P and never being able to rejoin my Marine Corps, how is it only 10%”.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting right hip condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 20031017
 VA – Dated: prior to VARD of 29 March 2004*
Condition
 Code Rating Condition Code Rating Exam
Healing Right Femoral Neck Stress Fracture 5003-5255 10% Right Femoral Neck Stress Fracture with Bursitis, Subchondral Cyst, and Sclerosis caused by Degenerative Arthritis 5252 10% not in file
No Additional MEB/PEB Entries
 Other x 0
Combined: 10%
 Combined: 10%
O riginal C&P exam, 20031009 and associated VARD of 20040329 not in file … VARD of 20080430 id ’ed original VARD’s rating.





ANALYSIS SUMMARY: The Board acknowledges the CI’s sentiment regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Femoral Neck Stress Fracture Condition. During Marine Corps boot camp training in early 2003, the CI developed right hip pain without history of direct trauma. Initially diagnosed with various muscle strains; a bone scan and magnetic resonance imaging later revealed stress induced changes about the right femoral neck (upper thigh at the hip) region without an associated fracture line. Despite non-surgical conservative treatment consisting of rest, ambulatory assistance, tolerant weight-bearing and sports medicine rehabilitation, the CI failed to resolve his painful symptoms. At the MEB examination completed 4 months prior to separation; the CI reported continued right hip pain which limited his activities. The MEB physical examination was brief and reported normal/full range-of-motion (FROM) of the hip. The presence of painful motion was not in evidence. The examiner indicated that the CI’s condition was a “slow healing process…not compatible with a return to full active military service.” An orthopedic examination conducted approximately the same time as the MEB (July 2003) also noted a FROM and a normal gait. The original orthopedic VA Compensation and Pension (C&P) examination was not in evidence and therefore, no post-service physical examination near his DOS was submitted. A 5-year remote C&P did reference the original C&P examination of 9 October 2003 resulting in a 10% VA rating.

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudged the right hip (femoral neck stress fracture) as unfitting and rated with an analogous code under 5255 (femur, impairment of, mal-union of) for the presence of a stress fracture on X-rays with slight hip disability. The VA coded the right hip as (femoral neck stress fracture and degenerative arthritis) 5252 (thigh; limitation of flexion) at 10% (source document absent). Having no documented measurements of compensable ROM restrictions of the thigh or the presence of any specific muscle paralysis or atrophy, a closely anatomic related code depicting the current pathology was sought. The Board acknowledged that in the presence of X-ray evidence which revealed a “healed” stress fracture, the PEB’s choice of code 5255 was not the best descriptor of the CI’s condition. A “healed” process would indicate minimal to no disability or impairment and therefore, a more accurate coding of 5003-5015 (Bone, new growth of, benign) would describe the actual pathologic process of healing bone with concurrent degenerative changes at a 10% rating. The Board agreed that there is no evidence of flare-ups or incapacitating episodes to support an additional rating or a 20% rating under the 5003 code. After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously agreed with the PEB’s rating decision; for no matter how it is coded, 10% is the maximum available in this case. The Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the femoral neck fracture condition.


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 (femur) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. 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 VASRD CODE RATING
Right Hip (Femoral) Stress Fracture 5003-5255 10%
COMBINED 10%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121206, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                          
         XXXXXXXXXXXXXXX
         President
         Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
 Subj:    PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CORB ltr dtd 2 May 14

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX , former USMC
-        XXXXXXXXXXXXXXXXXXXX , former USMC






XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)

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