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AF | PDBR | CY2013 | PD-2013-00109
Original file (PD-2013-00109.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-00109
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130801
SEPARATION DATE: 20030715


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-2 (Recruit) medically separated for a left femoral stress fracture condition. In December 2002, the CI complained of pain in his left femur after a fall from bleachers. A bone scan showed evidence consistent with a left femoral shaft stress fracture. Activity modification and protected weight bearing relieved the pain, but once activity advanced his pain immediately returned. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. It was determined that the CI was unsuitable for further military service and he was referred for a Medical Evaluation Board (MEB). The left femur condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “delayed healing of left femoral stress fracture, symptomatic” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “My request is twofold. My first request is that my active duty medical records be reviewed as well as any x-ray bone scan imaging. I received a DX of “femoral stress fracture” I believe that DX to be lesser than what I suffered. My injury was caused by a violent traumatic collision with a large boulder. When the accident occurred I was in full battle gear and was wearing a pack in excess of 100lbs. I had tumbled down a sharp inclined hill for 80-100ft. The only thing stopped me was a large boulder that impacted my femur. The boulder stopped my descent immediately and abruptly. I felt immediate sharp pain and an agonizing throb. I was never casted or even given some kind of restraint brace. It took me over a year to heal. I am still feeling effects from the injury that happened over 9 years ago. Arthritis at different levels is always present. More so after excessive activity or during and before bad weather. Winter temps also play a part in the level of aches.

My second request is that after all my medical records and images are reviewed and my injury is found to be more serious that a “stress fracture,” I respectfully request the board to give me a new Dx of femoral fracture and take into account how my injury effected me then and during present day. And increase my disability rating. Thank you for your time and consideration.”


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 left femur 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 (BCNR).
RATING COMPARISON :

Service IPEB – Dated 20030521
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
L Femoral Stress Fracture 5003-5255 20% Stress Fracture Left Femur 5255 10% 20030530
No Additional MEB/PEB Entries
 Other x 0 20030530
Combined: 20%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 20030827 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. 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. 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 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.

Left Femoral Stress Fracture Condition. The first documented visit for the left lower extremity was on 30 November 2002 when the CI presented with a 2-week history of left hip pain after falling about 6 feet. The CI stated that he had wanted to “tough it out.” Tenderness to palpation was noted on an otherwise normal examination including X-rays. He was treated with light duty for 3 days, Naprosyn, and crutches. A bone scan a week later was consistent with a stress fracture of the left proximal femoral shaft. The history noted that he fell from a bleacher. He was seen frequently over the next few months for persistent pain despite conservative treatment. A computed tomography (CT) scan of the left femur on 3 February 2003, accomplished a week after re-injury from jumping from a truck, noted a healing stress fracture without evidence of acute trauma. At a 24 February 2003 appointment, it was noted that he should have no adverse sequelae from the stress fracture, but that it could take another 8-12 weeks to heal. He was evaluated by orthopedics on 1 April 2003. It was noted that he had persistent pain refractory to both medications and physical therapy. His gait was normal and the range-of-motion of the hip reduced in extension in internal rotation; however, his measurements were equal to the unaffected right hip. The CI was referred to PEB due to a slowly healing stress fracture. The MEB report, dictated on 1 April 2003, 3 months prior to separation, was based on the above orthopedic examination. The examiner noted that the CI was unsuitable for further service due to the prolonged healing time and the increased demand which would be placed on him at his next duty station. At the VA Compensation and Pension exam performed 6 weeks prior to separation, the CI reported that he had rolled down a hill and his left leg struck a rock. This history was not found in contemporaneous records or in the subsequent treatment reports. He stated that he had pain in the left proximal femur, 4/10, with crossing his legs, in cold weather, and with prolonged standing. It flared to 7/10 with running and marching. There was tenderness over the proximal left femur, but the examination was otherwise normal including posture and gait. An X-ray of the distal femur and knee was normal.

The Board directs its attention to the rating recommendation based on the above evidence. The PEB coded the left femoral stress fracture condition as 5003-5255, degenerative arthritis and femur impairment, at 20%. The VA also coded the femur as 5255, but rated it at 10%. The Board noted that the CI essentially had a normal examination other than tenderness. His posture and gait were normal and a CT scan showed a healing stress fracture. The Board considered the various coding options for the femoral stress fracture, but none rose to a level higher than the 20% awarded by the PEB. 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 femoral stress 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 left femoral stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.


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
Delayed Healing of Left Femoral Stress Fracture Symptomatic 5003-5255 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130306, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX
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, former USMC






XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)


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