RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00555
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Trainee, medically separated for “chronic right foot and ankle pain” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 - 20070103	VARD - 20080531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot and Ankle Pain	5099-5003	0%	Chronic Right Foot and Heel Pain	5284	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Foot and Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot and ankle pain condition began in May 2006, during basic training, without specific injury.  The CI was initially treated for Achilles tenosynovitis and when the pain continued despite therapy a plain film X-ray revealed a stress fracture of the calcaneus.  After 4 weeks in a cast and further physical therapy a follow-up X-ray showed healing but not completely healed stress fracture.  The CI’s condition could not be rehabilitated to allow her to complete basic training.  There was no surgical indication.  The MEB forwarded “chronic right foot and heel pain” for PEB adjudication.  

At the Physical Therapy evaluation on 25 October 2006, 3 months prior to separation, the CI complained of resting foot pain of 3/10 and increased to 6/10 with ambulation.  Range of motion (ROM) was found to be dorsiflexion 20 degrees (normal 20) and plantarflexion 50 degrees (normal 45).  Gross manual muscle testing showed that bilateral lower extremity muscles exhibited 5/5 strength without complaint of pain.  The only maneuver that caused pain in the right heel was a full squat.  The 16 November 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of right ankle and foot pain that was made worse by prolonged standing and prevented the CI from running or walking long distances.  The physical examination showed the right ankle ROM to be dorsiflexion 20 degrees (normal 20) and plantarflexion 50 degrees (normal 45) with no indication of painful motion.  Tests for instability were negative.  The examiner noted tenderness along the right Achilles tendon as well as along the plantar aspect of the foot.  There was no VA Compensation and Pension examination in the available evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the foot and ankle condition together at 0%, analogously coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the chronic right foot and heel pain condition 0%, coded 5284 (foot injuries, other), citing the absence of moderate symptoms associated with the foot injury based on the STR.  The PEB combined the right ankle pain (Achilles tenosynovitis) and right foot pain (healing calcaneal stress fracture) conditions as a single unfitting condition analogously coded 5099-5003 and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The panel also noted that although these are separate diagnoses, they are manifested by the same disability, foot pain with standing, walking and running.  IAW VASRD §4.14, avoidance of pyramiding, the evaluation of the same disability under various diagnoses is to be avoided.  In this case the panel cannot recommend separate disability ratings. 

There was no X-ray evidence of arthritis to rate using VASRD code 5003 (arthritis, degenerative).  There was no limitation of motion of the ankle joint to support a rating under diagnostic code 5271 (limitation of motion) or 5024 (tenosynovitis) and the neither of the examinations in evidence noted the presence of painful joint motion.  The panel agreed that the ankle and heel pain present proximate to separation did not rise to the level of moderate for a 10% rating using code 5284.  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 chronic right foot and ankle pain condition.  

BOARD FINDINGS:  In the matter of the chronic right foot and ankle pain condition 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 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006518, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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