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AF | PDBR | CY2012 | PD2012 00988
Original file (PD2012 00988.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX    CASE: PD1200988
BRANCH OF SERVICE: Army         BOARD DATE: 20131107
SEPARATION DATE: 20020320


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard PVT/E-2(92A/Trainee) medically separated for stress fracture of the femoral head. The CI injured herself in basic training, was assigned to the physical training rehabilitation program, and was not able to attend Advanced Individual Training. The hip condition could not be adequately rehabilitated to meet the physical requirements of the training for her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The stress fracture of the femoral head, characterized as “stress fracture, right femoral head,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic pain, due to stress fracture of femoral head” as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “For the past few years the pain I’m feeling is getting worst. At the beginning I used to fell pain when I walked for long distances and/or periods of time but for the past 3 or 4 years I feel pain very bad all the time. The pain begins from the foot all the way up and ends at the lower back connecting with the hip. I must say it interferes with my daily activities such as shopping, cleaning my house or my car; and even worst at my intimate relations. For the past years I haven’t visit any kind of physicians because I got used to feel pain. Besides my job doesn’t give me the time to spend at medical appointments. I’ll like to be reviewed to see how worst or better my disability has become.”


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 stress fracture of the right femoral head 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 Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate 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 (DVA), operating under a different set of laws. The Board considers DVA 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.

RATING COMPARISON :

Service IPEB – Dated 20020227
 VA - (25 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
STRESS FRACTURE OF FEMORAL HEAD 5099-5003 0% R FEMORAL HEAD OF VASCULAR NECROSIS 5299-5255 10%* 20040413
No Additional MEB/PEB Entries
 Other x 0 20040803
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 41105 ( most proximate to date of separation [ DOS ] ). *Rating is effective March 11, 2004, the date the CI filed a VA claim.

ANALYSIS SUMMARY:

Right Hip Pain Condition: The CI began having right groin pain on 12 April 2001 after an Army Physical Fitness Test. She completed 9 weeks of basic training. She had normal X-rays, and an abnormal bone scan performed on 18 May 2001 with intense uptake of the right hip, and on 31 May 2001 a magnetic resonance imaging study of the right hip showed significant signal abnormality in the anterior portion of the right femoral head and neck that was compatible with the clinical suspicion of avascular necrosis. On an orthopedic consultation on 18 July 2001 she was diagnosed with stage I avascular necrosis of the femoral head and she was doing well with minimal discomfort walking and stair climbing. The narrative summary on 21 September 2001, 6 months prior to separation, notes the CI was continuing to have right hip pain, and inability to return to full activities. Physical examination revealed normal strength, normal sensation, with flexion of 135 degrees (125 is normal), abduction of 45 degrees (45 is normal), internal rotation of 30 degrees with pain (45 is normal) and external rotation of 50 degrees (45 is normal). At the VA Compensation and Pension exam performed on 13 April 2004, 2 years after separation, the CI reported flare-ups once per week of moderate intensity lasting an hour precipitated by squatting, bending, standing from a seated position, running, and jumping, alleviated with rest and medications. Physical examination revealed tenderness of the right inguinal area, no edema, no effusion, no instability, no weakness, no redness, no heat, no abnormal movement, no guarding of movement and no gait or functional limitation upon standing or walking. Ranges-of-motion (ROM) were flexion 100 degrees (125 is normal), extension 30 degrees (20 is normal), adduction 25 degrees (45 is normal), abduction 45 degrees (45 is normal), external rotation 60 degrees (45 is normal) and internal rotation of 40 degrees (45 is normal). Pain was noted with hip abduction between 30-45 degrees, without evidence of additional motion limitations due to pain, fatigue, weakness or lack of endurance following repetitive use during flare-ups.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD codes 5099 (rated analogously to)-5003 (degenerative arthritis) used by the PEB for a 0% rating. The Board noted there were no compensable ROM limitations under codes 5251, 5252 and 5253. Code 5003 stipulates when the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10% is for application for each such major joint or group of minor joints affected by limitation of motion. This recommendation includes consideration of functional loss in accordance with (lAW) VASRD §4.10 (functional impairment), §4.40 (functional loss), and §4.59 (painful motion). The Board considered code 5299 (rated analogously to) – 5255 (femur, impairment of) used by the VA for a 10% adjudication 25 months after separation. The Board found the degree of disability did not rise above the level of slight, for a higher adjudication of 20% in the CI’s favor at the time of separation. Additionally, the Board considered the diagnosis of avascular necrosis of the right femoral head and neck, was better supported by clinicians and radiological studies. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right hip pain condition (avascular necrosis).

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. As discussed above, PEB reliance on the USAPDA pain policy was operant in this case and the condition was adjudicated independently of that policy. In the matter of the right hip pain condition (avascular necrosis), the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Right Hip Pain Condition (Avascular Necrosis) 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120606, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20140002214 (PD201200988)


1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)


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