RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01783
BRANCH OF SERVICE:  Army	BOARD DATE:  20141010
SEPARATION DATE:  20041022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve PFC/E-3 (Basic Trainee) medically separated for a right foot condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “stress fractures, right foot”, was forwarded as the sole condition to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic right foot pain secondary to stress fracture of the right cuneiform tarsal bone” as unfitting, rated 0%, with presumptive application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting foot pain condition is addressed below; and, 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 Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040928	VA - (3 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain...	5022	0%	Stress Fracture Right Foot	5284	10%	20050201	
Other x 0  (Not in Scope)	Other x 3 	
Rating:  0%	Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20050419 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Foot Condition.  The first entry in the available service treatment record (STR) for the condition is from June 2004 (~4 months into basic training, ~4 months prior to separation); and, noted a 5-day complaint of right foot pain.  The CI was placed on crutches and referred to podiatry; X-rays were normal.  There are repeated STR entries documenting continuing right foot pain and treatment.  A bone scan from July 2004 suggested metatarsal and ankle bone stress fractures (“focally severe stress reaction versus early stress fractures in the vicinity of the right lateral cuneiform bone and base of the right fourth and fifth metatarsals”).  

She was managed with graduated weight bearing and orthotics, temporary profiles, and provided a 
30- day convalescent leave (mid-July to mid-August 2004).  Although initially improved (corroborated by less uptake on repeat bone scan), the pain recurred with resumption of training activities, and a MEB was initiated.

The narrative summary (NARSUM) was performed 5 weeks prior to separation and noted pain at rest rated 3/10, with exacerbations to 8/10 by activity.  The physical exam was significant for localized bony tenderness (correlating with bone scan findings), without swelling or other positive findings and, with no comment regarding gait or range of motion (ROM).  The impression recorded in the NARSUM was, “Stress fractures, right foot. Currently there are no surgical indications.  This should continue to improve; however, should this soldier continue basic training ... is at risk for further fractures.”  At the VA Compensation and Pension evaluation performed 3 months after separation, the CI reported bilateral foot pain rated 4/10 with exacerbations to 9/10; but, engaged in non-sedentary employment and was going to school, noting foot pain “after a long day.”  The VA physical exam noted a “limp favoring her right,” plantar tenderness and recorded normal values for all planes of ankle ROM.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s code 5022 as periostitis defaults to rating under 5003 (degenerative arthritis) and the DA Form 199 offers no rationale in justification of the failure to achieve a minimum compensable rating.  Members agreed that either VASRD §4.40 (functional loss) or §4.45 (principles of joint ratings) offer reasonable grounds for considering the minimum 10% rating under the PEB code.  The VA’s 10% rating was conferred under 5284 (foot injuries, other) for “moderate” disability, which also offers a 20% rating for “moderately severe” and 30% for “severe” disability.  Analogous coding to 5299-5279 (metatarsalgia) or 5299-5283 (tarsal or metatarsal bone malunion) were also entertained as additional routes to a higher rating, but members agreed that the analogous stretch entailed by those codes did not justify supplanting the more logical code of 5284.  With the conclusion that the disability present at separation was fairly characterized as at least moderate, members agreed that rating under 5284 was indicated IAW VASRD §4.7 (higher of two evaluations).  Higher ratings under 5284 were considered for moderately severe or severe disability; but, although the CI’s functional limitations appeared to prohibit strenuous activity, they did permit reasonable occupational functioning at the time of separation.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right foot condition under code 5284.

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, the Board unanimously recommends a disability rating of 10%, coded 5284, IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Stress Fractures and Chronic Pain, Right Foot	5284	10%	
Rating	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150006326 (PD201401783)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl		     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
				         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA