RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00458
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Marine, medically separated for “fifth metatarsal base fracture,” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively affect daily activities.  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 upon a 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 - 20070319	VARD - 20110812	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fifth Metatarsal Base Fracture	5284	10%	Residuals, Fracture, Left Fifth Metatarsal to include Scar	5299-5284	0%	20110726	
Surgical Repair	Not Unfitting / Cat II					
Right Ankle Sprain	Not Unfitting / Cat III	Right Ankle Sprain	5271	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY: 

Left Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fell 6 feet off of a rope obstacle and injured her left foot on training day 28.  An 11 January 2007 left foot X-ray showed a transverse fracture through the proximal metaphysis of the 5th metatarsal bone.  On 22 January 2007 the CI underwent an open reduction and internal fixation (ORIF) of a left 5th metatarsal base fracture.  A 30 January 2007 left foot X-ray showed no significant interval change in fracture alignment and no loosening or metal fracture of the orthopedic hardware.  At the 4-week postoperative orthopedic surgery evaluation, the CI had been in a cast for a month.  The left foot examination revealed no tenderness at the fracture site, a healing incision, and no signs of infection.  The cast was removed, a walking boot was applied, and the CI was directed to begin weight bearing in the boot.  

The 2 March 2007 NARSUM, 2 months before separation, recounted the history and interventions.  At the time of the NARSUM, the CI was 5 weeks postoperative and had transitioned to a walking boot, and was weight bearing as tolerated.  The left lower extremity examination revealed normal ankle and foot range of motion (ROM).  The left foot examination revealed a healing surgical incision.  At the base of the 5th metatarsal, there was no tenderness, swelling, or signs of infection.  The neurovascular examination was normal.  A left foot X-ray showed fracture fragments, and a 5th metatarsal intramedullary screw, which were unchanged in position from initial postoperative films.  There was consolidation at the fracture site at the superior and medial aspect, and a cortical gap at the plantar and lateral aspect.  The left foot examination revealed no tenderness at the fracture site, a well healed incision, and no signs of infection.  The neurovascular examination and strength were normal.  A left foot X-ray showed fracture fragments and hardware were unchanged in position.  There was substantial consolidation at the fracture site and still a gap at the plantar lateral border of the foot.  

The 26 July 2011 VA Compensation and Pension (C&P) examination, 4 years after separation, recounted the history and interventions.  The CI complained of constant, non-radiating, 5/10 pain in the ball of the left foot.  She reported flares to 9/10, 2-3 times per week, lasting several hours.  The CI reported associated stiffness and lack of endurance with no weakness, swelling, heat, redness, instability, giving way, or fatigability.  The physical examination documented a normal gait with no use of ambulatory aides or braces.  The left foot examination revealed a well-healed lateral surgical scar (1 cm by 0.25 cm).  There was a normal appearing longitudinal arch and weight-bearing fell on the middle of the foot.  There was no tenderness, painful motion, instability, weakness, deformity, lesions, callosity, breakdown, skin changes, onychomycosis, interdigital neuromas, hammertoes, pes cavus, pes planus, or claw foot.  Strength, sensation, pulses, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  Left foot X-rays showed an orthopedic screw transfixing an old healed fracture of the base of the 5th metatarsal with no acute bony pathology.  The assessment listed history of left foot 5th metatarsal fracture with subsequent ORIF.  The examiner documented “There is no objective evidence of a current condition pertaining to the left foot.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5284 code (foot injuries, other) for the Category I condition (left 5th metatarsal base fracture).  The listed Category II condition (surgical repair) was considered to contribute to the unfitting foot condition.  The VA assigned a 0% rating under an analogous 5284 code (foot injuries, other) based on the VA C&P examination 4 years after separation, citing there was no objective evidence of a current condition pertaining to the left foot.  Recognizing the remote temporal relationship (4 years) to the date of separation, the Board assigned less probative value to the VA C&P examination.  There was no weakness for consideration under 5277 (weak foot).  There was no evidence of sensory pathology for consideration under 5279 (metatarsalgia).  There was no deformity for consideration under 5276 (flatfoot, acquired), 5278 (claw foot), 5280 (hallux valgus), 5281 (hallux rigidus), or 5282 (hammer toe).  While X-rays showed an orthopedic screw transfixing an old healed fracture of the base of the 5th metatarsal, there was no deformity for consideration under 5283 (metatarsal bones malunion/nonunion of).  The code (5284) used by the PEB and VARD characterizes and rates impairment as moderate (10%), moderately severe (20%), and severe (30%).  Board members agreed that the symptoms more closely approximated the moderate (10%) than the moderately severe (20%) level of impairment.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 foot condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the Category II surgical repair, and Category III right ankle sprain, conditions were not unfitting.  While the contended right ankle sprain condition was implicated in the non-medical assessment (NMA), it was not judged to fail retention standards.  The contended surgical repair condition was not implicated in the NMA and was not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended Category II surgical repair and Category III right ankle sprain conditions, the Board unanimously recommends no change from the PEB determinations 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 20150602, 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 16 Nov 16

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

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)