RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03772
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070827

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 by the Informal Physical Evaluation Board (PEB) for “bilateral calcaneal stress fractures” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions found unfitting and not unfitting by the physical evaluation board.”  The applicant’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 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:

SERVICE PEB – 20070810	VARD - 20080201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Calcaneal Stress Fracture	5099-5003	0%	Calcaneal Stress Fx R…	5271	10%	20071109	
			Calcaneal Stress Fx L…	5271	10%	20071109	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Bilateral Ankle (Calcaneal Stress Fractures).  The CI had an X-ray and bone scan of the feet and ankles on 23 February 2007 which showed possible distal tibial (shin bone) stress fractures.  He was given duty limitations, but his pain persisted.  A bone scan on 24 April 2007 showed bilateral stress fractures of the heel bones (calcanei) along with possible degenerative changes of both ankles vice congenital variations.  He was examined that day and noted to have normal range-of-motion (ROM) of the ankle and a normal gait.  Both heels and ankles (at the end of the shin bone) were tender to palpation and motion was painful.  At the MEB narrative summary (NARSUM) examination, dictated by podiatry and dated 14 May 2007, 3 months before separation, the CI reported increasing pain since arrival at basic training without a specific injury.  He had not participated in impact sports (such as running) prior to beginning training.  He was also noted to be a cigarette smoker (which will delay healing).  On examination, he was noted to have tenderness over both heel bones and, on the left, at the junction between the heel and mid-foot.  He was unable to tiptoe due to heel pain.  He was diagnosed with bilateral calcaneal stress fractures.

At the VA Compensation and Pension (C&P) examination on 9 November 2007, 2 months after separation, the CI reported progressive pain.  He was working in a restaurant and his heel pain interfered with work efficiency.  He was able to stand 3-8 hours with only short rest periods and walk ¼ mile.  His gait was abnormal from poor propulsion.  He was noted to have bilateral pain with standing.  The ROM of the ankle joint was noted to be reduced.  The examiner cited the above X-rays and did not obtain new studies.

Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral calcaneal stress fracture condition at 0%, coded 5099-5003 (Analogous to degenerative arthritis), with probable application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated each foot for calcaneal stress fractures at 10%, coded 5271 (Limited motion of the ankle).  The Board observed that the unfitting calcaneal stress fractures would not be expected to limit the ankle ROM.  However, pain was consistently noted and the gait was abnormal shortly after separation.  The code 5284 (Other foot injuries) was thought to be more applicable to this condition.  A moderate level of disability supports a 10% rating for each foot.  Both the NARSUM and VA C&P noted problems with his gait.  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 each calcaneal stress fracture condition, coded 5284.

BOARD FINDINGS:  In the matter of the bilateral stress fracture condition, the Board unanimously recommends a disability rating of 10% for each foot, coded 5284 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Calcaneus Stress Fracture	5284	10%	
Right Calcaneus Stress Fracture	5284	10%	
RATING (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160005141, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final. Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,

Enclosure