RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02788
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Basic Trainee) medically separated for “right 2nd metatarsal stress fracture,” rated at 10%.

CI CONTENTION:  The applicant requests consideration of all of her conditions.  Her complete submission is at Exhibit A.

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 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 20070614	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5279	10%	Residuals R Ankle Stress Fracture	5271	0%	20070913	
Migraines	Not Unfitting	No VA Entry	
Other MEB/PEB Conditions x 0% (Not In Scope)	Other x 3  	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080208 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Foot Pain Condition.  The record shows that the CI developed right ankle pain in September 2006 during the second week of basic training.  She was found to have multiple areas of stress changes on bone scan and was treated with duty restrictions and physical therapy (PT).  She was able to resume limited training on 17 November 2006.  X-rays of her legs that same day were normal.  She was again seen on 14 December 2006 noting that the foot and shin pain had resolved, but that she now had right knee stiffness.  She was thought to have an overuse syndrome and was again given duty limitations for a month.  On 16 January 2007, she reported right hip pain and snapping; she was again thought to have an overuse syndrome as well as snapping hip syndrome.  Duty limitations were extended another 2 weeks.  On 22 February 2007, an X-ray of the right foot and ankle was suspicious for a stress fracture of the second long bone of the right foot.  The narrative summary (NARSUM) was dictated the next day, 4 months prior to separation.  The CI reported that she was unable to continue training due to her multiple stress fractures and shin splint pain.  A sedentary lifestyle prior to the military was noted.  On examination, she had tenderness over the right foot at the site of the suspected stress fracture.  It was anticipated that she would not be able to complete military training due to the multiple previous problems and separation was recommended.  At the VA Compensation and Pension (C&P) examination performed on 13 September 2007, 3 months after separation, the CI reported pain in the left lower leg (previous shin splint) if she jumped up and down, walked over 2 miles, or stood longer than 1 hour.  She reported pain in her right ankle if she wore any shoes other than running shoes or wore dress shoes for an extended period.  .  She was no longer symptomatic from the stress fracture of her right foot.  On examination, her posture and gait were normal and no assistive device was in use.  There was no tenderness to palpation, redness, or swelling.  The range-of-motion (ROM) was normal and exceeded VA normal values.  Painful motion was not present and signs of abnormal weight bearing absent.  The stress fracture of the right second metatarsal was without residua (resolved).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot pain (metatarsalgia [pain in the metatarsal]) at 10%, coded 5279 (metatarsalgia).  The VA determined that the metatarsal stress fracture was resolved and did not rate it although it used the 5279 code analogously (5299-5279).  The VA did rate the right ankle stress fracture at 0%, coded 5271 (limitation in motion of the ankle).  This was not considered by either the MEB or PEB and is therefore not within the Board’s scope of review.  Regardless, no pathology was noted on the MEB examination for the right ankle at separation.  The evidence supports that the unfitting right 2nd metatarsalgia condition (right foot pain) was resolved shortly after separation.  No rating higher than the 10% adjudicated by the PEB is supported by the evidence.  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 pain condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended migraine condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The migraine condition was not profiled.  No commander’s statement was in evidence.  It was judged to meet retention standards by the MEB.  It was reviewed and considered by the Board.  There was no performance based evidence from the record that it 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 the contended migraine headache 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 right foot pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine with and without aura condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140602, 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-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160003902 (PD201402788)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA