RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03892
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20071016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Trainee, medically separated for “left hip and bilateral foot pain,” with a disability rating of 0%.   

CI CONTENTION:  The applicant contends that he was given a higher rating for his conditions by the VA.  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 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 - 20070928	VARD - 20080722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Left Inferior Pubic Ramus…	5099-5003	0%	Stress Fracture of the Inferior Pubic Ramus…Left Hip	5252	10%	20080619	
Hammertoes and Pes Cavus Bilateral Feet…	EPTS	---%	Bilateral Pes Cavus with Hammertoes…	5278	50%	20080619	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Stress Fracture, Left Inferior Pubic Ramus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pubic ramus stress fracture condition began in April 2007 after injury in Basic Training.  A MRI performed in July 2007 confirmed a healing pelvic fracture.  The MEB NARSUM examination on 20 August 2007 (2 months prior to separation) noted complaints of residual mild pain in the left groin.  Physical examination showed no groin tenderness.  At the VA Compensation and Pension (C&P) examination in June 2008, performed 8 months after separation, the CI reported pain over the groin.  Physical examination did not specifically address the groin pain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis), citing USAPDA Pain Policy.  The VA assigned a 10% rating using the 5252 code (thigh limitation of flexion) based on the VA C&P examination 8 months after separation, citing painful or limited motion of the hip.  Although there were no objective findings of pain on physical examination, there was radiographic evidence of bony pathology and reports of pain with use for a 10% rating of IAW 4.40 (Functional Loss).  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 pubic ramus fracture condition.  

Hammertoes and Pes Cavus Bilateral Feet.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s foot condition began prior to service.  The CI initially presented with bilateral foot pain during Basic Training.  The MEB NARSUM examination on 20 August 2007 (2 months prior to separation) noted complaints of pain and blistering to the toes bilaterally when wearing military boots. The CI denied pain to the hammer toes prior to military service.  Physical examination showed resolving blisters to the toes, high arches (pes cavus), and severe bilateral hammer toes.  There was no tenderness to palpation to bilateral feet.  At the VA C&P examination in June 2008, performed 8 months after separation, the CI reported bilateral foot pain.  Physical examination showed bilateral hammer toes with redness, thickening of the skin with mild tenderness at the top of both big toes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the hammer toes and pes cavus bilateral feet conditions as unfitting, but existing prior to service (EPTS) and not permanently service aggravated; therefore, not ratable.  The VA assigned a 50% rating using the 5278 code (pes cavus) based on the VA C&P examination 8 months after separation, citing marked contraction of the plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity.  The Board noted documentation of hammer toes, mild pes cavus and callosities on the entrance examination. The CI reported that the pain had decreased when wearing tennis shoes instead of boots. The NARSUM examination demonstrated resolving blisters to the toes and no foot tenderness to palpation bilaterally. The VA examination documented that the CI was employed and continued to be on his feet much of the day, which exacerbated his foot discomfort. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that there was insufficient cause to recommend a change in the PEB adjudication for the hammer toes and pes cavus bilateral feet conditions.  

BOARD FINDINGS:  In the matter of the stress fracture, left inferior pubic ramus condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the hammer toes and pes cavus bilateral feet condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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	
Stress Fracture, Left Inferior Pubic Ramus 	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140829, 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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
 (PD201403892)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA