RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01363
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “left foot  pain and injury,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  The 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 – 20070109 	VARD - 20070810	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain and Injury 	5271	10%	Left Foot and Ankle Arthritis Status Post Talus, Cuboid and
Calcaneus Fractures	5284	30%	20070118	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Foot and Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a blast injury during Operation Enduring Freedom in February 2006.  He was medically evacuated and underwent immediate fasciotomies to his left foot.  In March 2006, he underwent an open reduction and internal fixation of his left foot and ankle (comminuted cuboid and talar) fractures.  Plain radiographs of the left foot and ankle in October 2006 showed improved soft tissue swelling, healing, and bony union of the fractured segments, bone spurs (degenerative joint), with no evidence of malalignment or avascular necrosis.  Despite treatment, the foot and ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “left foot and ankle pain secondary to closed left talus fracture and fasciotomies,” and “loss of ankle ROM” for PEB adjudication.  

At the 25 October 2006 MEB NARSUM examination, 3 months pre-separation, the CI reported a constant ache, weekly inversion injuries, and pain aggravated by stair climbing, walking more than 5 minutes, or standing for more than 10 to 15 minutes.  Physical examination showed a limping gait, dorsiflexion to 8 degrees (normal 20), and plantar flexion to 30 degrees (normal 45); with evidence of painful motion.  

At the 18 January 2007 VA Compensation and Pension (C&P) examination, 1 month pre-separation, the CI reported that walking and using stairs was painful, and the furthest that he could walk was about 50 yards.  Physical examination showed tenderness about the ankle, 4/5 weakness, and no crepitus.  Dorsiflexion was to 7 degrees, and plantar flexion was to 37 degrees; with evidence of painful motion.  During the gait, the foot was described as lowering abnormally, placing most of the weight on the lateral half of the sole, appearing somewhat rigid, and with no weight-bearing on the ball of the foot.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5271 (limited motion of the ankle), citing a 60% retained left ankle ROM, interpreted as “moderate.”  The VA rated the left foot condition 30% coded 5284 (foot injuries, other), based on the C&P examination 1 month pre-separation, citing a foot injury with severe symptoms.  

The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  Board members agreed the limitation of motion was no more than moderate, and did not support a rating higher than 10% under code 5271.  The Board then considered the examinations proximate to separation that described tenderness, abnormal gait, frequent inversion injuries, and significant limitations in walking (NARSUM and VA C&P examination).  Members agreed that these findings were consistent with a ‘severe’ foot injury in support of the maximum 30% rating under code 5284 (foot injuries, other).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the left ankle condition, coded 5284. 
 
The VA also assigned a separate 10% rating for painful scar.  The Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended.  

BOARD FINDINGS:  In the matter of the left foot condition, the Board unanimously recommends a disability rating of 30%, coded 5284 IAW VASRD §4.71a.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Foot Pain and Injury	5284	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005999, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure