RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01265
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Basic Trainee, medically separated for “chronic right foot 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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  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 - 20050420	VARD - 20050920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain 	5099-5003	0%	Healed Fracture Distal Second Metatarsal Shaft, Right Foot	5283	0%	20050811	
			Medial Tibial Plateau Fracture, with Patella Tendonitis, Right Knee	5257	0%	20050811	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	NSC	20050811	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had suffered a right knee tibial plateau stress fracture in August 2004 and then developed a right foot fracture (2nd metatarsal) in February 2005 after a long road march.  Diagnostic imaging in September 2004 showed the right tibial plateau stress fracture and imaging in February 2005 showed a right 2nd metatarsal fracture.  

The 30 March 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of right foot pain that increased with physical activity.  Physical examination showed a normal gait.  There was localized tenderness to the right 2nd metatarsal.  There was no swelling, ecchymosis, deformity, sensory loss, or vascular deficits in the right lower extremity.  Repeat radiographic (X-rays) studies on 7 March 2005 continued to show a right 2nd metatarsal fracture, with an increase in callous formation (signs of healing).  

At the 11 August 2005 VA Compensation and Pension evaluation, performed 3 months after separation, the CI reported less movement and strength in her right second toe with no pain where the fracture had been.  Physical examination showed a normal gait and stated discomfort of the right second toe on heel-toe walk.  The CI could squat without difficulty.  There was no tenderness of the right foot and the CI could flex and extend her toes.  The right lower extremity had normal strength, reflexes and vascular examination.  X-rays of the foot showed an old healed fracture of the second metatarsal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing tenderness of the forefoot, normal range of motion of the right lower extremity, and that recurrent stress fractures precluded return to training.  The VA also rated the right foot condition 0%, coded 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of), citing absence of moderate symptoms associated with malunion or nonunion of the tarsal or metatarsal bones.  

The fracture of the right 2nd metatarsal was healing well on the service examinations and completely healed on the VA examination after separation.  There was not sufficient evidence of malunion, nonunion, or moderate disability for any rating higher than the 0% awarded by the PEB and VA.  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 pain condition.  

Contended PEB Condition:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic right foot pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are 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 20150615, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008435, 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