RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04296
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Operations Specialist , medically separated for “nonunion, left fifth metatarsal, status post (S/P) open reduction internal fixation (ORIF) with subsequent pain and malunion,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for the left foot condition and five additional conditions not considered by the Medical Evaluation or Physical evaluation Boards.  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 -20070129	VARD - 20071107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Nonunion, Left Fifth Metatarsal, S/P ORIF with Subsequent Pain and Malunion	5283	10%	Left Foot Fracture	5284	0%	20071107	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Nonunion, Left Fifth Metatarsal, S/P ORIF with Subsequent Pain and Malunion.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left fifth metatarsal condition began in late 2003 after playing softball for physical training.  She underwent surgery for open reduction internal fixation in July 2005 because the fracture was not healing.  A bone scan in August 2006 showed some increased uptake in the left fifth metatarsal.  The CI was offered additional surgery to remove or replace the surgical hardware and the CI declined.  The MEB forwarded “closed fracture of metatarsal bones” for PEB adjudication.

At the MEB NARSUM examination dated 29 November 2006, 4 months prior to separation, the CI reported she could walk without difficulty but with prolonged walking or standing at times she had pain and swelling.  She reported her main issue was the inability to run.  On physical exam there was no redness or swelling of tenderness over the fracture site.  There was some pain over the surgical screw.  There was a normal foot arch and no evidence of reflex sympathetic dystrophy was noted.  Left foot X-rays showed incomplete healing in portions of the fifth metatarsal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 7 December 2006, 3 months prior to separation, the CI reported chronic left foot pain, with numbness in the big toe.  She reported being unable to stand, run, jump, etcetera and used orthotics in her shoes.  The physical exam noted only mild, symptomatic pes planus (flat foot).  

At the VA Compensation and Pension (C&P) examination in 7 November 2007, 8 months after separation, the CI reported pain in her left foot since her surgery.  The CI reported intermittent foot pain relieved by rest and medications and she was using of a bone stimulator to facilitate the fracture healing.  There were no flare-ups of the foot condition.  The CI was wearing bilateral foot orthotics and she reported they were effective.  On physical exam there was tenderness to palpation of the left foot arch.  There was a normal gait with no evidence of swelling, painful motion, instability, weakness, or abnormal weight bearing on the feet.  There was no flat foot deformity noted or any other deformity of the foot or toes.  The overlying skin and circulation of the foot were normal.  Left foot X-rays 23 October 2007 noted intact surgical screw with complete healing of the fracture, and the foot was otherwise unremarkable.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5283 code (malunion or nonunion of the metatarsal bones) VASRD condition name), citing pain and malunion.  The VA assigned a 0% rating using the 5284 code (other foot injury) based on the VA C&P examination 8 months after separation, citing no objective evidence on exam to warrant a higher evaluation.  At the MEB NARSUM exam there was evidence of nonunion of the fifth metatarsal with persistent symptoms of pain and swelling with use to warrant a 10% rating as adjudicated by the PEB.  At the C&P exam, 8 months after separation, the CI was noted to have a normal gait, with a normal exam of the left foot, except for TTP of the arch of the foot and X-rays noted that the fracture had completely healed.  There was no evidence of severe flat foot deformity, claw foot to warrant consideration of rating under the respective codes (5276, 5278).  There was no evidence to support moderately severe nonunion of the metatarsal or other foot injury which could be characterized as “moderately severe” for higher rating supported by the CI’s ability to walk and stand without problems on a routine basis, with intermittent problems with prolonged standing or walking and aggravation with impact activities.  There was therefore no route to a higher rating with any applicable VASRD 4.71a code.  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 fifth metatarsal condition.  

BOARD FINDINGS:  In the matter of the “left fifth metatarsal, status post open reduction, internal fixation, with subsequent pain and malunion” 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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141114, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 23 Mar 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)