RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01938
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150305
SEPARATION DATE:  20050401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1 (Seaman Recruit) medically separated for bilateral stress fractures of the navicular bones.  The bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty and was referred for a Medical Evaluation Board (MEB).  “Pathologic fracture of other specified site” and “congenital pes planus” was forwarded by the MEB to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “stress fracture, bilateral navicular bone” as unfitting, rating the right and left side 10% each, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The bilateral pes planus was determined to be a Category III condition (not separately unfitting and does not contribute to the unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I have been awarded 80% service-connected disability from the VA.  I have continuously tried to re-enlist in the military and have been told and come to the conclusion that my time in the military is and will forever be over.  I have already been told my multiple doctors that I won’t ben [sic] able to run again because of the injuries sustained during my time in the Navy.  I’m not one of those money hungry people but being in the Navy and eventually becoming a JAG officer has been my dream since I was a little kid and now that dream will never come true.  As well as now I can’t even pursue any of my other passions because of my injuries.  I have a 7yr son who loves to play football and basketball and I can’t help but to think that I won’t be able to do those things with him in the future not to mention the pain physically and emotionally that I am dealing with because of this.  Within this past year alone I have had to undergo 2 different medical procedures for one foot and have been advised that in about a year I will have the same thing to look forward to on my other leg.  My doctors have been as blunt as possible with me and let me know that I can expect to go through this for the rest of my life.”

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 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 20050208	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fractures, Bilateral Navicular Bone	5003-5283	10%	Left Foot Navicular Bone Stress Fracture	5284	10%	STR	
	5003-5283	10%	Right Foot Navicular Bone Stress Fracture	5284	10%	STR	
Other x 1 (Not in Scope)	Other x 6	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050422 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Bilateral Navicular Bone Stress Fracture Condition.  Review of the STR showed an initial visit for a complaint of one day left foot pain on 1 October 2004.  Although symptoms improved, gradual re-introduction of exercise resulted in bilateral foot pain.  After 5 weeks of pain, a bone scan on 2 December 2004 showed a stress fracture of the navicular bone of each foot.  

The narrative summary on 15 December 2004 (4 months prior to separation) noted that the pain was not improving, and prevented him from running, jumping or marching.  Physical exam showed painful ankle and foot motion, and tenderness of the mid-tarsal joints bilaterally.  Diagnoses of bilateral navicular bone stress fractures and pes planus were rendered.  The MEB exam on 17 December 2004 noted very minimal tenderness along the talonavicular joint, and decreased ankle dorsiflexion, foot inversion and foot eversion.  

Foot X-rays performed 4 months after separation were normal.  At a primary care clinic visit for a physical exam on 9 September 2005 (5 months after separation) the CI denied any joint pain.  Exam showed a normal gait and full range-of-motion (ROM) of all joints with “no limitations.”  At a VA clinic visit on 15 December 2005 (8 months after separation) the CI requested clearance to return to work due to his history of stress fractures.  He had no complaints and denied any pain.  Ankle ROM was noted to be full.  On 5 April 2006 (12 months after separation) the CI was seen for a hand injury sustained from a fall while playing football.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for each foot under a combined code 5003-5283 (degenerative arthritis; and tarsal, or metatarsal bones, malunion of, or nonunion of).  The VA used code 5284 (foot injures, other) based on the STR and likewise assigned a 10% rating for each foot.  Board members agreed that under the codes 5283 and 5284, the “moderately severe” descriptor was not depicted by the evidence and thus the next higher 20% rating was not supported.  There was no evidence of “marked” limitation of ankle motion to justify a 20% rating under either the code 5271 (ankle, limitation of motion of) or code 5003 (which defaults to limitation of motion).  Finally, the absence of joint ankylosis renders code 5272 (subastragalar or tarsal joint, ankylosis of) inapplicable.  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 bilateral navicular bone 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 bilateral navicular bone stress fracture 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 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			

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 Jul 15

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