RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01066
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “left foot stress fractures,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  His 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 - 20080303	 VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Stress Fractures	5099-5022	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Left Foot Stress Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot condition began in November 2006 during physical training.  Radiographic evaluations (bone scans in May and September 2007) showed stress fractures of the midfoot and heel (left cuboid and talus).  Despite treatment, the foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  

At six visits to physical therapy (PT) in August, September and October 2007, the physical examinations showed full range of motion.  Antalgic gaits were noted at four of those visits and painful motion was noted at three.  The 15 October 2007 MEB orthopedic NARSUM examination, 4 months prior to separation, noted complaints of pain, weakness, and giving way.  The physical examination showed lateral ankle tenderness (at the peroneal tendon, and lateral calcaneus and cuboid at the 5th metatarsal base) with weakness on eversion, dorsiflexion, and plantar flexion.  The stance was normal, however there was crepitus with range of motion and pain with tiptoe.  At a 24 October 2007 PT visit, the physical examination showed a normal gait with dorsiflexion of 10 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  There was pain with inversion and eversion, but no evidence of instability.  There was no VA Compensation and Pension (C&P) evaluation proximate to separation in evidence.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left foot stress fracture condition, coded 5099-5022 (analogously to periostitis), citing degenerative arthritis without loss of motion, but with a mild functional decrement.  The panel considered the evidence for a higher than 10% rating.  There was evidence of painful motion, crepitus, and radiographic findings in support of a 10% rating, as adjudicated by the PEB.  The panel considered a higher rating under the diagnostic code 5271 (ankle, limited 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 also supporting a 10% rating.  A higher rating of 20% was not indicated in the absence of markedly limited range of motion.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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 ankle stress fracture condition.  

BOARD FINDINGS:  In the matter of the left foot stress fracture 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
Exhibit B.  Service 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.