RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01333
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “bilateral calcaneal stress fracture,” with a disability rating of 0%.

CI CONTENTION:  The CI contends her condition continues to worsen and negatively impact daily activities.  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 - 20051020	VARD - 20060227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Calcaneal Stress Fractures…	5022	0%	Status Post Stress Fractures, Bilateral Calcaneus…	5299-5276	0%	20060118	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Calcaneal Stress Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for left ankle, right knee, and back pain in June 2005.  She was treated with crutches, medications, and duty restrictions.  X-rays, not in evidence, were noted to be normal in the NARSUM.  Her pain persisted though and she was then evaluated in podiatry on 5 July 2005 and diagnosed with a left ankle sprain with bilateral Achilles tendonitis and plantar fasciitis.  She was given an ankle brace and referred to physical therapy (PT).  On 9 September 2005, it was noted in PT that she had a high arch.  She was diagnosed with plantar fasciitis.  Her prognosis was thought to be poor secondary to both duration and lack of motivation.  She was also given orthotics (shoe inserts).  She continued to be seen by both podiatry and PT.  She was also diagnosed with stress fractures of her heels, based on findings on follow-up X-rays, and referred to an MEB on 28 September 2005.  The MEB NARSUM examination was dated 29 September 2005, 2 months prior to separation, noted complaints of bilateral foot pain.  She denied specific injury.  Despite treatment with crutches, medications, and duty restrictions, she had not been able to return to basic training and no longer was motivated to do so.  On examination, she was tender over both arches and heels.  She was diagnosed with bilateral heel stress fractures.  The MEB forwarded “calcaneal stress fractures” for PEB adjudication.  She was found to have tenderness of the left Achilles tendon on follow-up in podiatry on 2 November 2005, following the MEB and PEB.  At the VA Compensation and Pension (C&P) evaluation performed on 18 January 2006, 2 months after separation, the CI reported continued bilateral foot pain.  She had returned to the same job she held prior to enlistment.  She used no assistive devices.  On examination, she could remove her shoes and stockings without difficulty as well as heel and toe walk.  However, she reported pain with this in the soles and heels of both feet.  She had full range of motion of the ankles and a normal gait.  The ankles were stable.  The plantar fascia were tender to palpation.  The Achilles tendon showed normal alignment.  Abnormal shoe wear was not present.  X-rays were normal.  Pain on manipulation of the feet was not recorded.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, coded 5022 (periostitis), citing no significant loss of joint motion.  The VA also rated the bilateral foot condition 0%, coded 5299-5276 (acquired flatfoot), based on the VA C&P examination 2 months after separation, citing ‘mild’ symptoms.  Neither code supports a higher rating.  The Board also considered the code 5284 (other foot injuries).  While the CI was symptomatic, she had a normal gait.  This is not consistent with a level of impairment at the moderate level or higher.  The Board noted that the bilateral heel condition was rated as a single condition by the PEB.  The Board considered if each heel was separately unfitting, but noted that there was no route to a compensable rating for either heel, separately or combined, and that no advantage would be afforded the CI by such a recommendation.  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 condition.  

BOARD FINDINGS:  In the matter of the bilateral calcaneal stress fractures 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 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/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005990, XXXXXXXXXXXXXXXXXX. 

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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.

Sincerely,