RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXXXX                                                  BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1201143                                                                   SEPARATION DATE:  20021215 
BOARD DATE:  20130205 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty PV1/E-1 (31U10/Signal Support Systems Specialist) 
medically  separated  for  chronic  pain  after  surgical  pinning  of  her  left  femoral  neck  stress 
fracture.    In  October  2001,  she  was  diagnosed  with  a  left  femoral  hip  stress  fracture.    She 
underwent surgical treatment in November 2001 and her recovery was uneventful.  Her left hip 
condition could not be adequately rehabilitated and she continued to have persistent pain in 
her left hip.  Continued treatment did not allow the CI to meet the physical requirements of 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 MEB identified 
the  left  hip  pain  and  forwarded  it  as  the  only  condition  for  Physical  Evaluation  Board  (PEB) 
adjudication.  The PEB adjudicated the chronic pain status post (s/p) pinning of femoral stress 
fracture, healed as unfitting; and rated it 0%, specifically citing the US Army Physical Disability 
Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated with a 0% 
disability rating. 
 
 
CI CONTENTION:  “I’ve had continuous pain as well as new pain in my knees and lower back.  I 
have a hard time doing activities with my 8 y/o son.  Also, a woman from the VA said 20% for 
both hips was ridiculous, so I’m asking for a review.  Thank you.  I was 18 when I left the Army, 
17y/o when I joined.  I was hurt and took whatever they gave me (even took separation pay) on 
my Med. Board to get home.  I feel I may have been under-rated and taken advantage of.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in 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 conditions “identified but not determined to be unfitting by the PEB.”  The rating for 
the unfitting chronic pain s/p pinning left femoral stress fracture condition will be reviewed.  
The  knees  and  lower  back  pain  (LBP)  conditions  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  service  Board  for 
Correction of Military Records. 
 
 
RATING COMPARISON: 
 

VA (6 Mos. Post-Separation) – All Effective Date 20021216 
Exam 

Condition 

Rating 

0% 

Residuals of Left Femoral 
Neck Fracture 

Code 
5255* 

Rating 
20% 

Not Service-Connected x3 

Combined:  20% 

20030614 
20030614 

Service IPEB – Dated 20021030 
Code 

Condition 

Chronic Pain s/p Pinning Left 
Femoral Stress Fracture 

5099-5003 
↓No Additional MEB/PEB Entries↓ 

Combined:  0% 

*changed to 5299-5255 and rated 10% left hip; added 5299-5255 and rated 10% right hip; Bilateral factor 1.9 for 20% combined 
effective 20021216 
 
 

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impairment  with  which  her  service-incurred  condition  continues  to 
burden her.  It is a fact, however, 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.  This role and authority is granted 
by  Congress  to  the  Department  of  Veterans  Affairs.    The  Board  notes  that  the  scope  of  its 
recommendations does not extend to conditions which were not diagnosed or in evidence at 
the time of medical separation.  The Board acknowledges the CI’s assertions that “I may have 
been  under-rated  and  taken  advantage  of.”    It  is  noted  for  the  record  that  the  Board  has 
neither the jurisdiction nor authority to scrutinize or render opinions in reference to asserted 
improprieties in the disposition of a case.  The Board’s role is confined to the review of medical 
records and all evidence at hand to assess the fairness of PEB rating determinations, compared 
to VASRD standards, based on severity at the time of separation.  It must also judge the fairness 
of PEB fitness adjudications based on the fitness consequences of conditions as they existed at 
the time of separation. 
 
Chronic  Pain  s/p  Pinning  of  Femoral  Stress  Fracture,  Healed  Condition.    There  were  four 
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 chart below. 
 

PT exam 6.5 Mos. 

VA C&P ~22 Mos. Post-

NARSUM exam performed 

7 Mos. Pre-Sep 

MEB exam 7 
Mos. Pre-Sep. 

Pre-Sep. 

80° 
- 
30° 
4° 
- 

90° 
15° 
45° 
45° 

 

120° 
15° 
35° 
45° 
25° 

Sep 
90° 
10° 
40° 
20° 
20° 

Left Hip ROM 

Flexion (0-125°) 
Extension (0-20°) 

External Rotation (0-45°) 

Abduction (0-45°) 
Adduction (0-45°) 

Comment 

Normal Gait; Equal limb 
circumferences; Pos. 

Painful motion & 

tenderness to palpation 

lateral & greater 

trochanter; No pain & full 

ROM knee; Normal 
Strength & Sensation 

“Chronic left 
hip pain/ S-P 

Op” 

Non-antalgic gait; 
Pos. tenderness to 
palpation greater 
trochanter& ant. 
Hip; Pos. painful 
motion; Minor 

decrease in strength 
due to pain; Normal 

sensation 

10%* 

Normal Posture & gait; 
Pos. tenderness greater 
trochanter; Well healed 
surgical scar; No painful 
motion; Repeated or 
resisted motion cause 
pain & stiffness with 

diminished ROM of joints 

10%* 

§4.71a Rating 

10%* 

- 

* Based on VASRD §4.59 painful motion. 
 
At  the  MEB  exam  accomplished  7  months  prior  to  separation,  the  CI  reported  fractured  left 
femur and surgical placement of three pins in the left femoral neck.  The MEB physical exam 
findings are summarized in the ROM chart above.  The narrative summary (NARSUM) prepared 
4 months prior to separation noted the CI started experiencing pain in her left hip in October 
2001.  Later that month, she performed a mule kick and felt a pop in her left hip with extreme 
pain and inability to bear weight on her left side.  She was diagnosed with a left femoral neck 
stress fracture, was admitted to the hospital and underwent pinning of her left femoral neck 
stress fracture.  She had an uneventful recovery.  The CI stated that she had persistent pain in 
her left hip when she walked any moderate distance or when she sat in one position or stood 
for too long.  She had not been able to run since surgery and she had not been able to do any 
sort of activity other than light activities of daily living.  She took Tylenol for these pains which 
had not been very successful in relieving her pain.  Significant physical examination findings are 
summarized in the left hip ROM chart above.  Radiographic studies included plain film X-rays 

2                                                           PD1201143 
 

that showed good healing and good hardware placement in the left hip.  Magnetic resonance 
imaging (MRI) study of both hips was performed in December 2001 and no femoral fracture 
was noted on the right side.  There was no pain in the right side.  Her condition was stable and 
was not expected to worsen or to improve.   
 
At the VA Compensation and Pension (C&P) exam accomplished 6 months after separation, the 
CI reported a history similar to the one above with the following significant additions.  The CI 
was 7 months pregnant at the time of the exam.  The CI reported having had physical therapy 
one time.  She reported that in mid-January 2001 she started to experience right hip pain.  She 
returned for X-rays and a fracture was noted.  There was no treatment performed at that time 
as the CI was still on light duty secondary to her left hip surgery.  The CI reported that she still 
experienced bilateral inguinal pain when she stood greater than 20 minutes.  She stated that 
she did have difficulty climbing stairs secondary to her pain.  Significant physical exam findings 
were decreased ROM bilaterally secondary to pain in the lower extremities at the hip.  Another 
C&P examination was accomplished 22 months after separation and the CI related the same 
history as above.  She was not pregnant  and she was taking non-steroidal anti-inflammatory 
medications at that time.  Significant physical exam findings are summarized in the ROM chart 
above. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  applied  the  analogous  VASRD  code  of  5099-5003  for  the  chronic  pain  after  pinning  of 
femoral neck stress fracture condition.  They applied the USAPDA pain policy and rated it 0% 
disabling based on slight/occasional pain.  While that rating methodology complied with service 
policy in effect at the time, the Board is charged with applying VASRD only rating criteria for its 
final  rating  recommendations.    Based  on  the  limited  data  contained  in  the  6  month  post-
separation C&P exam performed when the CI was 7 months pregnant, the VA initially applied 
VASRD code 5255 (Femur, impairment of), and rated the condition 20% disabling based on the 
subjective designation of moderate hip disability due to malunion of the femur.  After receiving 
a more comprehensive C&P examination 22 months after separation, the VA later changed its 
coding scheme to an analogous code 5299-5255 and rated the same condition 10% disabling 
effective the day after final separation.  Based on that comprehensive examination, there was 
no hip condition that permitted a compensable evaluation based on specific VASRD diagnostic 
codes,  therefore,  it  is  assumed  that  the  10%  rating  was  based  on  painful  motion  or  slight 
disability of the hip or knee, as the VARD did not clearly state the basis of the rating.  At the 
time  of  separation,  the  documented  ROM  and  movement  of  the  CI’s  left  hip  was  not 
compensable IAW VASRD codes 5250 thru 5254.  There was no hip or knee disability due to 
malunion as required for VASRD code 5255.  There was however, adequate evidence of painful 
motion  of  the  left  hip.    The  analogous  coding  scheme  applied  by  the  PEB  allows  for  the 
application  of  VASRD  policy  §4.59  in  rating  the  CI’s  hip  pain.    The  VASRD  code  5003, 
degenerative arthritis states, “When however, the limitation of motion of the specific joint or 
joints involved is no compensable 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, 
to  be  combined,  not  added  under  diagnostic  code  5003.    Limitation  of  motion  must  be 
objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of 
painful motion.”  The proper application of this VASRD code yields a 10% rating.  If the VASRD 
analogous  code  of  5299-5255  is  utilized,  the  subjective  rating  criteria  of  slight,  moderate  or 
marked hip or knee disability would be required for rating purposes and at no time proximate 
to separation did the evidence document any knee or hip disability beyond “slight.”  Application 
of the analogous code 5299-5255 would also yield a 10%, evaluation.  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  chronic  pain  s/p  pinning  of  femoral  stress 
fracture, healed condition. 
 

3                                                           PD1201143 
 

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  for  rating  chronic  pain  s/p  pinning  of  femoral  stress 
fracture, healed was operant in this case and the condition was adjudicated independently of 
that  policy  by  the  Board.    In  the  matter  of  the  chronic  pain  s/p  pinning  of  femoral  stress 
fracture,  healed  condition,  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: 
 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

Chronic Pain s/p Pinning of Femoral Stress Fracture, Healed 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120611, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

4                                                           PD1201143 
 

MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXX, AR20130003775 (PD2012001143) 
 
 
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 
 
 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

5                                                           PD1201143