RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00532
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080602

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “foot injury due to stress fracture of the left calcaneus,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20080506	VARD - 20090105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injury due to Stress Fracture of the Left Calcaneus	5284	10%	Left Calcaneal Stress Fracture	5271	0%	20081219	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Foot Injury due to Stress Fracture of the Left Calcaneus.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left calcaneous (heel) injury began in September 2007 after ruck marching and running in basic training.  Radiographic studies (October 2006 bone scan and March 2007 X-rays) showed evidence of stress fracture.  The CI was issued a series of physical profiles, crutches, a CAM (controlled ankle motion) walker, arch supports, heel cups and physical therapy without alleviation of pain.  There was no surgical indication, and treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left calcaneal stress fracture” for PEB adjudication.  

At the 10 April 2008 MEB NARSUM examination, 2 months prior to separation, the CI reported walking with pain, inability to run or march, and no pain at rest.  Physical examination showed tenderness at the heel, inability to bear weight due to pain, and that she walked on tiptoe.  There was pain on dorsiflexion of the ankle, with full range of motion (ROM) of the ankle joint.  

At the 19 December 2008 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported soreness and a “shooting pain” when walking.  The CI denied difficulty with gait, balance or strength.  Physical examination showed no ankle instability or swelling.  Left ankle ROM showed 20 degrees of dorsiflexion (normal) and normal plantar flexion (normal 45) without pain.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left foot Injury, coded 5284 (foot injuries, other), citing “preserved foot function permitting walking and standing with pain.”  The VA rated 0% for the left foot injury, coded 5271 (ankle, limited motion of), based on the VA C&P examination 6 months after separation, citing “no objective medical evidence of limited motion and thus no evidence that there is moderate limited motion of the ankle.”  The panel considered the rating under the diagnostic code 5271, limited ankle motion, and whether the limitation of motion was moderate or marked.  All panel members agreed the limitation of motion was no more than moderate, therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the ankle.  The panel considered alternative VASRD ankle (5284) and analogous codes, but all were less applicable and not advantageous to rating.  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot Injury.  

BOARD FINDINGS:  In the matter of the left foot Injury and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150601, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure