RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01366
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20070301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, Basic Trainee, medically separated for “left calcaneal stress fracture” and “right tibial plateau stress fracture,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI contends that he was not evaluated for his back injury or arthritic pain and that he continues to have constant pain in his right knee.  His 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:  

IPEB - Dated 20070124	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Calcaneal Stress Fracture	5279	10%	Left Calcaneal Stress Fracture	5284	10%	STR	
Right Tibial Plateau Stress Fracture	5022	0%	PFS of the Right Knee with …	5024-5262	10%	STR	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  20%	

ANALYSIS SUMMARY:  

Left Calcaneal Stress Fracture Condition.  The record shows that the CI developed left heel pain while in basic training.  An X-ray on 27 June 2006 was consistent with a healing stress fracture.  He was treated with duty restrictions (which included convalescent leave), physical therapy (PT), and occupational therapy without resolution of his pain.  A bone scan on 8 September 2006 showed a persistent stress fracture of the left calcaneus (a heel bone).  The narrative summary (NARSUM) was dated 29 November 2006.  The CI was noted to have symmetric ankle motion; painful motion was not recorded.  The left heel was painful to compression.  Complete healing was estimated to take another 9-18 months.  The CI did not appear for his VA Compensation and Pension (C&P) examination scheduled for 10 January 2007.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left calcaneal stress fracture at 10%, coded 5279 (metatarsalgia).  The VA also rated the left calcaneal stress fracture at 10%, but coded the condition 5284 (other foot injuries).  The Board noted that this is a better coding option, but provided no rating advantage to the CI.  The Board found no route to a rating higher than 10% regardless of the coding option used.  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 calcaneal stress fracture condition.  

Right Tibia Plateau Stress Fracture Condition.  The CI also noted the onset of right knee pain during basic training and was found to have an effusion and a positive patellar (kneecap) grind on evaluation on 27 June 2006.  An X-ray on 14 August 2006 showed a small effusion, but no evidence for a stress fracture or other bony pathology.  However, a bone scan on 8 September 2006 did show increased activity for the tibial aspect of the knee (shin bone) which could indicate a developing stress fracture.  Despite rehabilitation (as noted above for the left heel), the CI had persistent right knee pain and was referred for MEB.  The NARSUM examiner recorded symmetric ROM at 0-130 for both knees.  Painful motion was not documented, but the right knee was mildly tender to palpation.  The knees were noted to be stable.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 0%, coded 5022 (periostitis).  The VA rated the right knee at 10%, coded 5024 (tenosynovitis) and 5262 (impairment of the tibia and fibula).  The Board considered the evidence.  The knees were stable and the ROM limitation was non-compensable.  Evidence of a meniscal injury was absent.  Painful motion supports a 10% rating under any of the above codes IAW VASRD §4.59 (painful motion).  The Board found no route to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition.  

BOARD FINDINGS:  In the matter of the left calcaneal stress fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right tibial plateau stress fracture condition, the Board unanimously recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Left Calcaneal Stress Fracture	5279	10%	
Right Tibial Plateau Stress Fracture	5022	10%	
COMBINED (Incorporating BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160005896 (PD201401366)

1 . 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, accept the Board's recommendation to modify the individual's disability rating to 20% without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA