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AF | PDBR | CY2013 | PD-2013-02657
Original file (PD-2013-02657.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02657    
BRANCH OF SERVICE: Army  BOARD DATE: 20150724
SEPARATION DATE: 20051031


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-3 (Combat Medic) medically separated for a left hip condition which could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition “status post left femoral neck open reduction internal fixation [ORIF]” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic pain, left hip” as unfitting, rated 20%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: Her condition continues to worsen and negatively impact her daily activities. Her complete submission is at Exhibit A.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20051014
 VA (12 Mo. Post-Separation)*
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Left Hip Fracture 5099-5003 20% Residuals, Left Hip Fracture Status Post Surgery 5299-5255 10% 20061022
Other MEB/PEB Conditions x 0 (Not In Scope)
 Other x 0
Combined: 20%
 Combined: 10%
* Derived from VA Rating Decision (VA RD ) dated 20061106 (most proximate to date of separation [ DOS ] ).




ANALYSIS SUMMARY :

Left Hip. The service treatment record and narrative summary (NARSUM) indicated that the CI had hip pain during basic training of 6 months duration for which she did not seek treatment. She then fell and broke her left femur (5 months prior to separation). There was radiographic evidence of an acute fracture of the femoral neck and evidence of a previous fracture of the pelvic ring (pubic ramus with callous formation). She underwent the above ORIF procedure and post-operative physical therapy, but was unable to resume her military training. The MEB’s DD Form 2808, Report of Medical Examination, (7 weeks prior to separation) documented joint tenderness and “marked decreased range-of-motion [ROM], only about 50% abduction or rotation can be attained.”

The NARSUM was performed 6 September 2005 (2 months prior to separation). The CI reported hip pain “that [was] made worse with prolonged standing, ambulation, or with any attempts to do impact activities.” The physical exam documented an antalgic gait, the absence of joint tenderness, and equivocal testing for hip pathology; with no indication of femoral instability, capsular defects, degenerative arthritis (log roll, heel tap, straight leg raise). The recorded ROM measurements (passive) were flexion to 115 degrees (normal 145, compensable at 45), abduction to 55 degrees (normal 45, compensable at less than 10), and extension to 25 degrees (normal 20; compensable when limited to 5).

At the VA Compensation and Pension (C&P) joint examination performed on 12 October 2006 (12 months after separation), the CI reported “sometimes discomfort and slight limitation with movement and hard feeling;” but, denied effusion, locking, flareups, limitations on walking or standing, use of assistive aids, or episodes of incapacitation. The examiner noted full time employment and opined that the condition imposed “no significant effect [on] occupational activities.” The VA physical examination documented a normal gait (as did a general C&P examination the same day), but did not comment on specific joint findings. The recorded ROM measurements (active) by the VA were flexion to 75 degrees, abduction to 33 degrees, and external rotation to 25 degrees (normal 45, compensable at less than 15).

The Board directed attention to its rating recommendation based on the above evidence. The PEB’s 20% rating under the analogous code 5003 (degenerative arthritis) is derived from stipulations of the USAPDA pain policy (American Medical Association pain ratings); which, IAW DoDI 6040.44, must also be applied by the Board if it is favorable to the VASRD. The VA’s 10% rating was under analogous application of code 5255 (femur, impairment of) which offers ratings for contiguous hip disability: 10% for “slight,” 20% for “moderate,” and 30% for “marked.” Members agreed that the functional and occupation limitations in evidence did not support a conclusion that disability was “marked,” thus no rating higher than the PEB’s 20% determination can be recommended under 5299-5255. There is no compensable ROM limitation under the applicable codes; and, there is no ankylosis, fracture deformity, flail joint or instability, or nonunion/malunion that would achieve a rating higher than 20% under any alternate code available in VASRD §4.71a. 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 hip 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. This mandate is caveated, however, with the stipulation that Service or DoD regulations which are favorable to the applicant will supersede; and, the Board’s recommendation for the right hip condition is thus derived from the USAPDA pain policy as applied by the PEB. In the matter of the left hip 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131206, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
                 
SAMR-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 XXXXXXXXXXXXXXXXXXXX , AR20150015856 (PD201302657)

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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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