RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00861
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E1, Electrical/Mechanical Equipment Repairman, medically separated for “left calcaneus stress fracture,” and “right sacral stress fracture,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  “I have been found to have more problems believed to be present at the original review.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB - 20071219	VARD - 20080714	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Calcaneus Stress Fracture	5003-5283	10%	Left Calcaneal Stress Fracture	5299-5021	0%	20080326	
Right Sacral Stress Fracture	5003	10%	Right Sacral Stress Fracture	5299-5021	0%	20080326	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Calcaneus Stress Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left calcaneus (heel) stress fracture condition began in October 2007 while running during recruit training.  Radiographic studies (bone scan) on 15 November 2007 showed a left calcaneus stress fracture.  The CI was placed on crutches and referred into the stress fracture rehabilitation program.  On 26 November the CI returned for follow-up and complained of increased pain with activities.  Despite treatment, the left heel fracture condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left calcaneus stress fracture” for PEB adjudication.  At the MEB NARSUM (2 months prior to separation) the CI reported that she was unable to run for greater than a quarter mile, or stand for a prolonged period of time without left heel pain.  The examiner noted that the left heel remained tender to palpation.  

At the VA Compensation and Pension (C&P) examination on 18 March 2008, performed a month after separation, the CI reported constant left heel pain; which increased with physical activity; and weakness associated with standing or walking.  Physical examination showed a normal gait and range of motion (ROM) without signs of abnormal weight bearing.  There was left calcaneal tenderness to palpation.  Radiographic studies (X-ray) of the left foot were normal without evidence of arthritic changes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left heel condition 10% coded 5003-5283 (degenerative arthritis tarsal, or metatarsal bones), citing localized tenderness to palpitation.  The VA rated the left heel condition 0% analogously coded (5299-5021, myositis), citing “normal [ROM] that was not limited by repetitive use, pain, fatigue, weakness, or lack of endurance.”  The examiner noted the CI had “subjective complaints” of tenderness to palpation of the left calcaneus and there was no functional loss with repetitive ROM.  The Board considered alternative VASRD ankle and foot analogous codes, but all were less applicable and not advantageous to rating.  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 calcaneus stress fracture.  

Right Sacral Stress Fracture.  According to the NARSUM, the CI’s right sacral stress fracture condition began in November 2007 with insidious onset.  Radiographic studies (bone scan) on 15 November 2007 showed a right sacral stress fracture.  At the sports medicine clinic appointment on 19 November 2007, the examiner noted that the CI had tenderness in a discrete area along the border of the sacroiliac joint and the pelvis.  The CI was placed on crutches and referred into the stress fracture rehabilitation program.  Despite treatment, the right sacral stress fracture condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “right sacral stress fracture” for PEB adjudication.  At the MEB NARSUM (2 months prior to separation) the CI reported discomfort with sitting and certain motions of the back.  The examiner reported that the CI’s spine revealed no asymmetry and normal muscle tone without “significant atrophy or abnormal movements.” Thoracolumbar ROM was noted as full and normal.  There was tenderness to palpation over the right sacral wing.  At the VA C&P examination in March 2008, performed a month after separation, the CI reported aching and sharp pain.  Physical examination showed normal posture and no radiation of pain on movement.  The examiner noted that the CI’s ROM was not “limited by repetitive use, pain, fatigue, weakness, lack of endurance, or incoordination.”  There was tenderness to palpation of the right posterior scrun and sciatic notch area.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right sacral stress fracture condition 10% coded (5003, degenerative arthritis), citing arthritis of a minor joint.   The VA rated the right sacral stress fracture condition 0% analogously coded (5299-5021, myositis), citing “subjective complaints of tenderness to palpation of the right posterior sacrum and sciatic notch area.”  Radiographic studies (X-rays) of the sacra area were “completely normal.”  The examiner stated there was “no functional loss” due to this condition.  Although there was no limitation of thoracolumbar spine or hip motion to support a minimum rating, the Board agreed a 10% rating for painful motion or functional loss was justified in the MEB NARSUM for subjective reports of painful motion, presence of localized tenderness, and radiographic evidence of a sacral fracture.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 right sacral stress fracture conditions.  

BOARD FINDINGS:  In the matter of the left calcaneus stress fracture condition and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  In the matter of the right sacral stress fracture conditions and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140217, 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 19 May 16

      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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN