RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX                                                           CASE:  PD-201500152
BRANCH OF SERVICE: Army                                                 SEPARATIONDATE:  20060911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “chronic right foot pain and ankle stiffness…”  with a disability rating of 20%. 

CI CONTENTION:  The CI contends for his unfitting foot and ankle and his not unfitting PTSD. The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060801	VARD - 20070816	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Right Foot Pain and Ankle Stiffness

	5284-5271	20%	Comminuted Fracture of Right Calcaneus, Status Post Open Reduction Internal Fixation with Residual Orthopedic Hardware, Hallux Valgus and Pes Planus	5284	20%	20070425	
			Right Ankle Sprain	5271	10%	20070425	
Mild PTSD	Not Unfitting	PTSD	9411	70%	20070426	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

Chronic Right Foot Pain and Ankle Stiffness.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right foot pain and ankle stiffness condition began 7 December 2005 after a blast injury while deployed.  X-ray revealed a calcaneal fracture in the right foot.  He underwent surgery with bone graft.  During the April 2006 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported limited use of his foot when carrying weight while walking and with overall range of motion (ROM). 

During the 7 June 2006 MEB NARSUM examination, 3 months prior to separation, the examiner noted complaints of “pain 90% of the time.”  The pain was mainly in the heel and right ankle joint and average pain was 4-5/10.  The examiner noted some partial numbness along the lateral aspect of his heel and foot at the surgical site.  Since the accident, he had been unable to run, walk a maximum of a quarter of a mile, or lift and carry 30 pounds.  He was not using a cane or walker but walked with something of a limp.  The condition improved with rest.  Medication included an opioid and a non-steroidal anti-inflammatory medication.  He was performing administrative duties.  Physical examination of the right foot showed dorsiflexion limited to 0 degrees (normal 0), plantar flexion to 20 degrees (normal 45), inversion to 8 degrees and eversion to 10 degrees.  He walked with a slight antalgic gait.  Neurovascular examination revealed decreased sensation to light touch over the lateral aspect of the heel and foot with no foot drop.  The NARSUM referenced the March 2006 diagnosis by the orthopedic surgeon: calcaneal fracture with traumatic arthritis, decreased sensation over the sural nerve, loss of motion of the ankle, pes planus due to the fracture and mal union of the fracture with persistent shortening, and varus deformity of his calcaneus bone.  The May 2006 X-ray showed a “lateral calcaneus stabilizing device with several screws, with healing fracture, in grossly normal alignment.”  

At the April 2007 VA Compensation and Pension (C&P) examinations for feet and joints, 7 months after separation, the CI reported chronic pain in the right heel and bilateral ankle sprain, more on the right than on the left.   He wore a corrective shoe and worked security.  The examiner noted, “…the right ankle is deformed with the heel and [has] slight tenderness, [with a] decreased right foot medial arch.”  The right foot was flat.  Physical examination showed a mild slight antalgic gait with weakness and pain.  “Motor was 4/5 ankle and foot, more on the right than on the left.”  Sensory was grossly intact with normal reflexes and pulses.  Right ankle ROM showed dorsiflexion to 0 degrees (normal 0) and plantar flexion to 20 degrees (normal 45).   There was muscle atrophy of the right calf from disuse.   X-rays of the right heel and the right ankle showed a healed fracture of the right calcaneus with residual orthopedic hardware.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right foot pain and ankle stiffness condition 20%, coded 5271 (ankle, limited motion of), citing marked limitation of motion.  The VA rated the comminuted fracture of the right calcaneus condition 20%, coded 5284 (foot injuries, moderately severe), based on the C&P examination 7 months after separation, citing continued pain and functional limitation of the right foot. 

The Board agreed that the right foot pain and ankle stiffness were related injuries and the direct result of the calcaneal fracture and surgical repair so it was not possible to rate them separately per VASRD 4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  There was an absence of dorsiflexion and partial absence of plantar flexion that resulted in a marked limitation of motion.  The CI was unable to engage in certain activities but was able to work security.   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 chronic right foot pain and ankle stiffness condition.   
  
Contended PEB Condition: PTSD. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The MEB Addendum noted a diagnosis of mild PTSD was rendered with a Global Assessment of Functioning (GAF) score of 70 (mild symptoms, impairment).   The PTSD condition was not profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended PTSD condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic right foot pain and ankle stiffness condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD 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 20150205, 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 
XXXXXXXXXXXXXXXXXX, AR20170002976 (PD201500152)

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