RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00565
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150507
SEPARATION DATE:  20050215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Seaman Recruit) medically separated for a left leg condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Rating or satisfy physical fitness standards.  She was placed on light duty and referred for a Medical Evaluation Board (MEB).  The “left tibia stress fracture” condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded one other condition (right foot metatarsalgia) for PEB adjudication.  The Informal PEB adjudicated “left middle tibia stress fracture” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be Category III, a condition that is not separately unfitting and does not contribute to the unfitting condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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:

IPEB – Dated 20050105	VA* – ~1 Mo. Post-Separation  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Middle Tibia Stress Fracture	5022-5003	10%	Status Post Left Tibial Stress Fracture	5262	NSC**	20050310	
Right Foot Metatarsalgia	Cat III	Bilateral Pes Cavus with Pes Planus and Right Metatarsalgia	5299-5276	10%	20050310	
Other x 0 (Not In Scope)	Other x 8 	
RATING:  10%	COMBINED:  20%	
*Derived from VA Rating Decision (VARD) dated 20050822 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Leg Condition.  Absent history of direct trauma, the CI developed left leg pain, aggravated with running in mid-2004 while in basic training.  Initially thought to be a stress fracture, radiographic testing was normal.  Conservative treatment measures included restrictions and light duty which provided her intermittent relief.  After several exacerbations of painful flare-ups, a bone scan performed on 15 November 2004 revealed a stress fracture in the mid-section of the left tibia.  With progressive painful symptoms, she was referred to an MEB.

At her MEB narrative summary exam performed 1 December 2004 (10 weeks prior to separation) she reported the inability to run for greater than a quarter mile or walk/stand for a prolonged period of time without left lower leg pain.  Her physical examination (PE) was detailed and focused to her lower extremities.  No abnormalities were identified.  The examiner’s diagnosis remained as left middle tibia stress fractures based upon the bone scan results of 2 weeks prior.  Additionally, the examiner noted, “She [CI] will be ambulating as tolerated for a total of six to eight weeks.  It will likely take six months to one year for the [CI’s] injuries to heal and restore her physical condition to a level compatible with military service.”  The VA Compensation and Pension examination performed on 10 March 2005, a month after separation, documented the following in regards to her left tibia, “She had pain, but that has gotten better.  She has no pain.  No dysfunction.  No discomfort.  Everything went away when she was able to stop running.”  Her focused tibial PE was normal.  Her diagnosis was specifically listed as, “status post episode left tibial stress fracture, currently resolved.  No palpation discomfort.  No residuals.  The diagnosis is confirmed on X-rays.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB chose a dual code of 5022 (periostitis) and 5003 (arthritis, degenerative) with no explanatory comment as for its basis.  VASRD code of 5022 is frequently utilized to identify the pathology of stress fractures for impairment ratings.  The VA rated the same condition under code 5262 (impairment of tibia and fibula) citing that it was not service-connected due to absent permanent residual or disability for a “resolved” condition.  All Board members agreed that near the time of separation (as depicted by the VA examination) the CI was without complaint and presented with a normal examination, thus resulting in a non-positive impairment rating.  IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to the CI’s application.  Therefore, all evidence considered, there was not reasonable doubt in the CI’s favor supporting a change from the PEB’s 10% rating decision for the left leg condition.

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the “right foot metatarsalgia” condition was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Absent trauma, the CI was evaluated by podiatry and diagnosed with right-sided plantar fasciitis in late 2004.  Right foot X-rays were normal.  A clinical encounter dated 15 December 2004 (2 months prior to separation) noted a completely normal right foot examination despite the CI’s complaint of right foot pain.  Her diagnosis was “subjective foot pain; possible metatarsalgia.”  Board members deliberated and agreed that there was no performance-based evidence from the record that the right foot condition significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s Category III designation for the right foot metatarsalgia condition  and so no additional disability rating is recommended.

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 middle tibia stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right foot metatarsalgia condition, the Board unanimously recommends no change from the PEB determination as a Category III condition.  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 20140616, 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) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd XX Sep 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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC