RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00586
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Trainee, medically separated for “bilateral foot injuries” with a combined disability rating of 20%.  

CI CONTENTION:  The CI requests the Board consider the unfitting conditions.  The CIs 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 - 20090424	VARD - 20091030	
Condition	Code	Rating	Condition*	Code	Rating	Exam	
Bilateral Foot Injures due to Stress Fractures of the Navicular	5284	10%	Plantar Fasciitis, Left Foot	5277	0%	20090904	
	5284	10%	Plantar Fasciitis, Right Foot	5277	0%	20090904	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
*The VA Examiner noted the history of navicular fractures, but changed the diagnosis to Plantar Fasciitis, a different condition.

ANALYSIS SUMMARY:  

Bilateral Foot Injures.  According to service treatment records and the medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented for bilateral knee, shin, and ankle pain on 5 February 2009, 5 weeks after initial entry.  Her examination showed tenderness in all six locations.  X-rays were normal.  Despite limited duty, her pain increased.  A bone scan on 24 February 2009 showed bilateral navicular (an ankle bone) stress fractures.  She was referred to podiatry where she was noted to have a flexible high arch (which predisposes an individual to navicular stress fractures) and given arch supports and crutches.  She was also entered into the MEB process as she was not expected to recover sufficiently to complete training in a timely fashion.  The NARSUM on 2 March 2009 recorded tenderness over the bilateral navicular bones and adjacent medial cuneiform bones.  The range of motion (ROM) of the ankles, sub-talar joints, and metatarsophalangeal joints (toe ray bones) was normal.  At the VA Compensation and Pension (C&P) examination performed on 4 September 2009, 4 months after separation, the CI reported pain, fatigability, and weakness in her feet.  She was not under treatment.  The gait and X-rays were normal, but both feet were tender.  Bilateral plantar fasciitis was diagnosed.  The CI did not wish to pursue an evaluation of the ankles (which includes the navicular).  The ROM examination recorded the right ankle as full and the left ankle nearly full with dorsiflexion of 16 degrees (20 normal). 

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating to each foot, coded 5284 (other foot injuries at the moderate level), citing the navicular stress fractures.  The VA did not rate the CI for the navicular fractures, but did rate the CI at 0% each for bilateral plantar fasciitis, coded 5277 (bilateral weak foot).  The Board considered the evidence.  Painful motion of each foot on the physical therapy evaluation and the limited left foot motion support a 10% rating for each foot.  No route to a higher rating was found.  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 bilateral foot injuries due to stress fracture of the navicular condition.  

BOARD FINDINGS:  In the matter of the bilateral foot injuries due to stress fracture of the navicular 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 20150602, with attachments
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 XXXXXXXXXXXXXXXXXXXXX, AR20170000269 (PD201500586)

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