RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00711
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E3, Infantryman, medically separated for “bilateral healing stress fractures/metatarsalgia,” with a disability rating of 10%.

CI CONTENTION:  The CI contends for the unfitting feet conditions and additional conditions not identified by the MEB or PEB.  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 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 - 20030709	VA rating Decision in evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Healing Stress Fractures/Metatarsalgia	5279	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Healing Stress Fractures/Metatarsalgia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began in April 2002 after reporting to sick call with no specific trauma.  He was first seen in the troop medical clinic on 29 April 2002 with a 6-week history of right foot pain after a road march.  He was noted to have a right second metatarsal (MT) stress fracture and placed on crutches for 1 week.  A bone scan confirmed the clinical and X-ray findings.  When evaluated in podiatry on 13 May 2002, the CI reported that he was pain free with non-weight bearing.  The use of crutches and a wooden shoe (to prevent bending) was extended 2 more weeks.  At a 19 June 2002 podiatry follow-up, the CI reported left foot pain which was greater than the right.  
An X-ray on 26 September 2003 showed well healed stress fractures of the left 3rd and 4th MT bones and a suggestion of a healed right 3rd MT.  Repeat X-rays on 6 December 2002 were similar.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 May 2003, 3 months prior to separation, the CI reported foot trouble since basic training.  On examination, tenderness and decreased flexion of the MTs was noted.  At the MEB NARSUM examination dated 19 June 2003, 2 months prior to separation, the CI reported the use of a walker on and off for 14 months.  On physical examination, he had bilateral tenderness at multiple MT joints.  The MEB forwarded “healing stress fractures of bilateral feet” and “metatarsalgia” to the PEB.  No VA Compensation and Pension (C&P) evaluation was in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain condition 10%, coded 5279 (anterior metatarsalgia, unilateral, or bilateral).  A 10% rating is the maximum for the code 5279 whether unilateral or bilateral.  However, the bone scan showed continued bilateral uptake consistent with an ongoing stress related process.  The Board determined that the code 5284 (other foot injuries) better described the clinical condition.  Limitations in running and prolonged standing were noted on the NARSUM, but none for walking.  The commander used the CI as a staff duty runner.  This level of impairment was found to be best described as at a moderate level.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the each foot, coded 5284.  

BOARD FINDINGS:  In the matter of the bilateral foot pain condition, the Board unanimously recommends a disability rating of 10% for each foot, coded 5284 IAW VASRD §4.71a, for a combined rating of 20% with application of the bilateral factor.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Foot Metatarsalgia and Healing Stress Fractures	5284	10%	
Right Foot Metatarsalgia and Healing Stress Fractures	5284	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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 
XXXXXXXXXXXXXXXXXX, AR20170002444 (PD201500711)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA