RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01758
BRANCH OF SERVICE:  Army	BOARD DATE:  20140710
SEPARATION DATE:  20070327

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63B/Helicopter Mechanic) medically separated for a right foot condition.  The foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The CI was permitted to take the alternate Army physical fitness test (aerobic portion).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The foot condition, characterized as “chronic right foot pain, s/p ORIF of Lisfranc fractures and dislocations,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded status post right shoulder dislocation and left knee pain as not disqualifying.  The PEB adjudicated “chronic right foot pain” as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining two conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right foot condition is addressed below along with the right shoulder and left knee. No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20070201	VA – 8 Months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic R Foot Pain	5284	10%	Post-Operative Residuals, R Foot Lisfranc FX and Fx of Metatarsals 2, 3, and 4	5284	10%	20071203	
S/P R Shoulder Dislocation	Not Unfitting	Residuals of R Shoulder Subluxation	5201	0%	20071203	
Left Knee Pain	Not Unfitting	L Knee Medial Collateral Ligament Strain Residuals	5260	10%	20071203	
Other x 0 (Not in Scope)	Other x 2	20071203	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20080321, which backdated ratings to day after separation.   Original VARD of 20071018 used STRs as VA Exam cancelled and only rated the right foot at 0%.

ANALYSIS SUMMARY:

Chronic Right Foot Pain.  The CI presented to the emergency room on 5 January 2006 after a motorcycle accident at about 30 mph.  X-rays showed a displaced fracture of one of the mid-foot bones (4th metatarsal) of the right foot.  He was initially treated with a compressive cast.  Five days later, he had an open reduction and internal fixation (ORIF, surgical pinning of the fracture).  Fractures of two other mid-foot bones were noted at surgery (second and third metatarsals) as well as a Lisfranc injury, a fracture dislocation of one of the mid-foot bones and the tarsal bone of the ankle.  His post-operative course was uneventful and two of the pins were removed (one spontaneously came out).  However, it was determined that he would not be able to return to full duty status and he was entered into the Disability Evaluation System process.  An L3 profile was issued on 23 August 2006.  At the MEB examination on 31 October 2006, the CI was noted to have pain with dorsi-flexion and plantar flexion as well as to compression of the mid-foot.  Bilateral, asymptomatic pes planus was noted as well; this had been present at accession.  On 9 November 2006, range-of-motion measurements were obtained in physical therapy.  Dorsi-flexion was slightly reduced (by 5 degrees) compared to the left and 10 degrees less than the VA standard of 20 degrees, but plantar flexion was identical and again slightly reduced (5 degrees) from the VA normal value of 45 degrees.  The narrative summary (NARSUM) was dated 8 January 2007, less than 2 months prior to separation.  The CI reported significant foot pain which precluded extended walking and precluded running.  He was unable to accomplish his duties as a helicopter mechanic.  The examiner referred to the MEB examination for findings.  At the VA Compensation and Pension examination was performed on 3 December 2007, 8 months after separation.  The CI reported stiffness, pain and fatigability of the right foot.  On examination, the 6 foot CI was down to 266 pounds from the over 300 pounds measured at the MEB examination.  His strength was normal and atrophy was absent.  Examination of the right foot was noted as normal.  X-ray examination showed the presence of two screws with one appearing to possibly be loose.  There was good alignment and no bony destruction or erosion was noted.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both used the code 5284, foot injuries and rated the right foot at 10% for a moderate disability.  The Board considered the findings and found no route to a rating higher than that adjudicated by both the PEB and VA.  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 foot condition.

Contended PEB Conditions.  The CI also contended for the not unfitting right shoulder and left knee.  The Board’s main charge is to assess the fairness of the PEB’s determination that these conditions were 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.  Neither condition was profiled at the time of separation although the shoulder had been temporarily profiled after an injury 2 years prior to separation.  Neither was implicated in the commander’s statement nor judged to fail retention standards by the MEB.  At the NARSUM, the CI reported that his shoulder only bothered him if he bench pressed which he now avoided.  He reported intermittent, improving pain of the left knee since basic training; a magnetic resonance imaging was normal.  Both were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either contended conditions and so no additional disability ratings are 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 right foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right shoulder and left knee conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXX AR20150006673 (PD201401758)

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