RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00422
BRANCH OF SERVICE: Air force		SEPARATION DATE:  20070305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Security Forces Trainee, medically separated for “right third metatarsal (midfoot) stress fracture,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 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 - 20070125	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Third Metatarsal (Mid Foot) Stress Fracture	5283	10%	No VA Disability Claim Filed	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Third Metatarsal (Mid Foot) Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted right foot pain in basic training, but was able to graduate.  In technical school, her symptoms increased and she was diagnosed with a stress fracture both clinically and on bone scan.  She was treated with duty limitation, physical therapy, and partial weight bearing (with crutches), but her symptoms persisted.  A repeat X-ray on 12 October 2006, 5 months prior to separation, showed a healing stress fracture of the third mid-foot bone (metatarsal: between the heel and toes).  A bone scan the following week was also consistent with a healing stress fracture, but a recurrent injury could not be excluded as the CI remained symptomatic.  An orthopedic evaluation on 7 December 2006 recorded a mildly antalgic (abnormal due to pain) gait.  However, she was noted to have a normal gait the next day for the MEB examination.  She was then entered into the MEB process.  The MEB NARSUM examination on 11 December 2006, 3 months prior to separation, noted complaints of continued pain with activity.  Physical examination revealed right midfoot tenderness.  Her strength was decreased (4/5) as was the range of motion.  It was thought that she would be unlikely to complete training for security forces and separation was recommended.  The commander noted that the CI was not motivated to continue active duty.  The MEB forwarded “right midfoot stress fracture” for PEB adjudication.  No further clinical records were in evidence prior to separation other than a profile renewal on 31 January 2007 which noted that she was stable, in no acute distress, and controlled her pain with rest and medications.  

The CI did not file a VA disability claim; and therefore, there was no VA Compensation and Pension evaluation for Board review.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right third metatarsal (midfoot) stress fracture condition 10%, coded 5283 (malunion of the metatarsal bones at the moderate level).  There was no VA rating.  Board members agreed that the STR and VA evidence supported a 10% rating.  The CI was not limited from any activities of daily living.  There was no evidence of moderately severe malunion, nonunion, (5283) or foot injury (5284) for a 20% rating.  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 right third metatarsal stress fracture condition.

BOARD FINDINGS:  In the matter of the right third metatarsal (midfoot) stress fracture 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, 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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear Ms. XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00422.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings