RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01120
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Signal System Support Specialist, medically separated for “chronic pain left leg secondary to left fibular stress fracture” rated at 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  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 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 - 20070924	VARD - 20080116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Leg Secondary to Left Fibular Stress Fracture	5099-5003	10%	Stress Fracture, Left Fibula	5262	0%	20071203	
Right Foot Stress Changes Following Fracture of Base of 5th Metatarsal	5099-5022	(EPTS)	Stress Fracture, Right Fifth Metatarsal	5283	NSC	20071203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Leg Pain and Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic left leg pain condition began in March 2007 with pain onset while running.  A bone scan revealed a left mid fibular (lower leg) stress fracture.  Follow-up plain X-ray showed a healing stress fracture.
Despite treatment, the left lower leg condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty or training requirements and the CI was referred for MEB.  The MEB forwarded “left fibular stress fracture” for PEB adjudication.  

At the MEB NARSUM examination dated August 2007, 2 months prior to separation, the CI reported pain in the left leg while standing and running.  Physical examination documented tenderness to palpation over the upper left fibula with no gross deformity.  Range of motion for the knee and ankle joints were reported as normal.  Formal physical therapy range of motion measurements in September 2007, 1 month prior to separation, recorded left knee motion of 0-140 degrees (normal 0-140) and left ankle motion of dorsiflexion to 5 degrees (normal 20) and plantar flexion to 45 degrees (normal 45) with pain as the limiting factor.  

At the VA Compensation and Pension (C&P) examination in December 2007, performed 2 months after separation, the CI reported only occasional pain with flare-ups after walking long distances that resolved on sitting.  Physical examination showed no swelling, deformity or discoloration or discomfort of the left fibula.  Gait and heel and toe walk were normal.  There were no sensory deficit or skin changes noted.  There was no disability documented for the knee or ankle joint.  X-ray documented an old left mid fibular fracture which was healed.  The diagnosis was left fibula fracture, with residual occasional discomfort.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative (hypertrophic or osteoarthritis)), citing ankle motion limited by pain and “rated as slight/frequent” (likely applying the Army pain policy).  The VA assigned a 0% rating using the 5262 code (tibia and fibula, impairment of;) based on the VA C&P examination 2 months after separation, citing only occasional discomfort.  There was no evidence of moderate knee or ankle disability to support a 20% rating under the 5262 code (tibia and fibula, impairment of), and additionally, the post-separation VA examination indicated improvement of the condition.  There was no limitation of motion to support a rating under the respective knee or ankle codes.  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 chronic left leg pain condition.  

Right Foot Stress Changes … 5th Metatarsal.  According to the STR and the MEB NARSUM, the CI’s right foot condition began in June 2006, due to a right foot injury prior to the CI’s entry into service.  He was seen by orthopedics for right foot pain with activity and was using a crutch.  Examination documented a tender swollen base of the 5th metatarsal.  X-rays documented an acute non-displaced fracture in the right foot (Jones Fracture) with questionable old fracture healing or stress fracture.  The foot was casted and follow-up X-rays showed healing progressing.  The fracture was considered healed in September 2006 as noted by the added entries on the service entry physical.  During the second week after entry the CI complained of right foot pain over the prior fracture site and was treated with a short leg cast for 8 weeks, with return of foot pain after rehabilitation.  The MEB forwarded “right stress fracture of base 5th metatarsal” for PEB adjudication.  The MEB noted the right foot condition as EPTS, not incurred while entitled to base pay, incurred prior to service, or permanently aggravated by service.  

At the NARSUM examination dated August 2007, 2 months prior to separation, the CI reported pain in right foot while standing and running.  Physical examination showed right foot with pain on dorsiflexion, full range of motion on dorsiflexion and plantar flexion as above.  Skin was intact with no color changes, no increased sweating, and no skin sensitivity.  

At the VA Compensation and Pension (C&P) examination in December 2007, performed 2 months after separation, the CI reported foot pain that was only occasional since leaving active duty.  Physical examination showed no swelling, deformity or discoloration or discomfort of the foot.  Rising up onto toes was normal and heel and toe walk was without any difficulty.  X-rays showed an old fracture involving the proximal 5th metatarsal bone without acute disease noted.  The diagnosis was right 5th metatarsal fracture, without residuals.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned an EPTS determination under an analogous 5099-5022 code (periostitis), indicating the condition was unfitting, but not compensable due to EPTS without permanent service aggravation.  The VA did not service-connect the right foot condition citing that the injury was not incurred while on active duty and that there were no residuals and no aggravation shown.  There was clear evidence that the CI had an EPTS 5th metatarsal fracture and the improvement in the CI’s foot condition by the post-separation VA examination indicated that there was no permanent aggravation of the preexisting condition.  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 right foot condition.  

BOARD FINDINGS:  In the matter of the left leg pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right foot 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 20150601, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160014392  (PD201501120)

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