RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2015-01412
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050330

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 “chronic bilateral foot and ankle pain” with a disability rating of 0%.  

CI CONTENTION:  “I continually have swelling and pain in my feet due to the multiple fractures.”  The 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 - 20050317	VARD - 20050916	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot and Ankle Pain	5099-5003	0%	Residuals of Stress Fracture Bilateral Ankles	5271	0%	20050809	
			Residuals of Stress Fracture Bilateral Feet	5284	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot and Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot and ankle conditions began with right ankle pain in November 2004 during the second week of training, without a specific trauma or mechanism of injury.  Symptoms increased despite use of a brace and on 26 November 2004 the CI was admitted to the infirmary with bilateral ankle pain and effusion.  X-rays and bone scan revealed bilateral ankle and foot stress fractures.  After therapy and convalescent leave, the bilateral foot pain recurred after returning to marching.  The MEB forwarded “bilateral ankle and foot stress fractures” for PEB adjudication.  

At the 8 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported bilateral foot and ankle stress fractures with pain.  Physical examination showed normal gait with no ankle swelling or weakness.  There was tenderness at the cuneiform area of both feet.  

The 2 March 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of bilateral feet and ankle pain of 3/10 increasing up to 7/10 "if I do any physical activity like lifting, running, or prolonged standing."  Physical examination showed a normal gait with examination of the bilateral feet and ankles being “totally normal except for mild tenderness to the right foot cuneiform bones.”  There was full range of motion (ROM) bilaterally with no heel tenderness with squeeze.  

At the 9 August 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant 1/10 pain in the feet and increased pain after walking several blocks, with no symptoms at rest.  Physical examination showed no local abnormalities or crepitus of the ankles.  Ankle strength was normal with a normal ROM without pain, fatigue, weakness, or lack of endurance with repetition.  The bilateral feet appeared normal and were not tender.  Repetitive motion of the foot and toes was normal without pain, fatigue, weakness, or lack of endurance with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot and ankle condition 0%, coded 5099-5003 (analogous to degenerative arthritis), with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the bilateral ankle conditions 0%, coded 5271 (ankle limitation of motion) and bilateral foot conditions 0%, coded 5284 (foot injuries, other), based on the C&P examination 4 months after separation, citing the absence of moderate symptoms associated with the foot injury and the absence of moderate limitation of motion of the ankles.  

There was no limitation of motion of either ankle joint to support a rating under diagnostic code 5271 (limitation of motion) and the MEB and VA C&P examinations did not note the presence of painful joint motion.  The gait was normal and there was no evidence of a weak foot, or moderate foot disability to achieve a 10% rating for either foot, and there was no evidence of degenerative changes in the ankles and/or feet to warrant the 10% rating under code 5003 for X-ray evidence of involvement of two or more major joints or two or more minor joint groups.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral foot and ankle condition.  

BOARD FINDINGS:  In the matter of the bilateral foot and ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010041, XXXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXX

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,					      
						      					
Enclosure