RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03389
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091002

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E2, Basic Trainee, medically separated for “foot injuries other, due to right calcaneal and left navicular stress fractures …,” rated 10% for each foot, with a combined disability rating of 20%.  

CI CONTENTION:  The CI requests consideration of all conditions in her application.  She states her rating for the VA is currently at 40%.   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 based on 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 –20090922	VA- 20200526 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries Other, due to Right Calcaneal and Left Navicular Stress Fractures	Right	5284	10%	Right Heel Stress Fracture	5284	10%	20091207	
	Left		10%	Left Foot Strain	5284	10%		
Enlarged Thyroid	Not Unfitting	Enlarged Thyroid	7902	NSC	20091207	
Pits in Tonsils	Not Unfitting	No VA Placement	
Recurrent Infections URI	Not Unfitting	Sinusitis	6512	NSC	20091207	
Hip Pain	Not Unfitting	Right Hip Strain	5255	10%	20091207	
		Left Hip Strain	5255	10%	20091207	
Shin Splints	Not Unfitting	Shin Splints, Right	5299-5262	0%	20091207	
		Shin Splints, Left	5299-5262	0%	20091207	
Dry Scalp with Psoriasis	Not Unfitting	No VA Placement	
Hyperlipidemia	Not Unfitting	No VA Placement	
Depression	Not Unfitting	Adjustment Disorder with Depressed Mood Associated with Left Foot Strain	9434	10%	20100216	
Suicidal Ideations/Attempt	Not Unfitting	No VA Placement	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	NSC	20091207	
Fainting Spells	Not Unfitting	No VA Placement	
Iron Deficiency Anemia	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Foot Injuries Other, due to Right Calcaneal and Left Navicular Stress Fractures.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in March 2009 during basic training physical activities and into Advanced Individual Training (AIT).  Diagnostic imaging (bone scan and X-ray) in April and July 2009 was consistent with mild stress fractures in the right calcaneus and left navicular areas with ongoing healing.  Despite treatment, the foot conditions could not be adequately rehabilitated to meet the physical requirements of the CI’s training requirements and the CI was referred for a MEB.  The MEB forwarded “Bilateral Foot Stress Fracture” for PEB adjudication.  

At the MEB examination dated 23 July 2009, approximately 2 months prior to separation, the CI reported chronic bilateral foot pain despite profiles, medications, arch supports, heel lifts crutches, and medications.  She could not tolerate wearing boots and could only wear soft shoes.  On examination, gait showed mild pronation in late midstance.  There was tenderness over the left medial navicular calcaneus with mild pronation.  There was also tenderness over the right poster superior calcaneus with pain with resisted eversion to the medial arch area and right medial arch pain on rise-up on tiptoe.  The NARSUM indicated a flexible pes cavus foot type with full range of motion (ROM) to the ankle, subtalar and metatarsophalangeal joints.  Dorsiflexion for the left and right ankle were 10 degrees and 15 degrees respectively (normal 20).  Plantar flexion was 40 degrees for the left ankle and 45 degrees for the left ankle (normal 45). There was no painful motion and Deluca was negative

At the VA Compensation and Pension (C&P) examination in December 2009, performed approximately 2 months after separation, the CI reported chronic pain in the right heel and left navicular area.  On exam, gait was normal.  Bilateral lower extremity strength, reflex and sensory testing was normal.  Each foot had callus to medial great toe and heel areas. Dorsiflexion for the left and right ankle were 10 degrees and 10 degrees respectively (normal 20).  Plantar flexion was normal bilaterally at 45 degrees.  There was no painful motion and Deluca was negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% combined rating – rated 10% for the right foot and 10% for the left foot under the 5284 code (foot injuries, other), citing “moderate injury with preserved ability to walk albeit pain.”  The VA also assigned a 10% rating for the right heel stress fracture and a 10% rating for the left foot strain each using the 5284 code based on the VA C&P examination approximately 2 months after separation, citing moderate symptoms demonstrated on exam.  The Board considered whether either foot warranted any higher rating (§4.7) under code 5284 than the “moderate” 10% awarded by the PEB and VA; however, all Board members agreed that the impairment did not more nearly approximate moderately severe to support a higher rating.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus) or astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  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 foot and right foot (bilateral foot) injuries (stress fractures) condition.  

Contended PEB Conditions:  Enlarged Thyroid, Pits In Tonsils, Recurrent Upper Respiratory Infections (URI), Hip Pain, Shin Splints, Dry Scalp With Psoriasis, Hyperlipidemia, Depression, Suicidal Attempt, Migraines, Fainting, And Iron Deficiency Anemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were 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.  None of the contended conditions were profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the “foot injuries other, due to right calcaneal and left navicular stress fractures …” (bilateral feet) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended enlarged thyroid, pits in tonsils, recurrent URI, hip pain, shin splints, dry scalp with psoriasis, hyperlipidemia, depression, suicidal attempt, migraines, fainting, and iron deficiency anemia 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.  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 20140630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160011340 (PD201403389)

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