RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01567
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E2, Basic Trainee, medically separated for “foot injuries,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 panel 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 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 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 - 20090702	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries 	5284	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 	

ANALYSIS SUMMARY:  

Foot Injuries.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot injuries condition began in February 2009 during Basic Training.  Radiographic studies were normal. A bone scan showed stress fracture of the second metatarsals bilaterally and stress changes of the cuneiforms, right calcaneus and tibiotalar joint.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “s/p stress fracture, left foot with chronic pain,” “s/p stress fracture, left tibiotalar joint with chronic pain,” and “s/p stress fracture, left calcaneus with chronic pain” for PEB adjudication.  

At the Physical Therapy examination on 4 May 2009, 2 months prior to separation, the CI reported to be doing better was able to complete a 3-mile run on a treadmill without pain.  Physical examination showed pain level 0/10 bilateral.  Lower extremity; no tenderness on palpation of the ankles with full range of motion (ROM).  Feet:  no tenderness and no pain with single leg jump bilaterally.  Motor strength:  no ankle weakness was observed.  Gait and stance:  normal, heel walking was normal, toe walking was normal.  

The MEB NARSUM examination on 15 June 2009, 1 month prior to separation, noted complaints of (5/10) pain in left foot, left heel and left leg with prolonged walking, standing, running.  Physical examination revealed: bilateral ankle with negative soft tissue swelling, negative decreased ROM, negative tenderness.  Bilateral foot examination revealed:  negative soft tissue swelling, and negative tenderness with the exception of the left foot with some tenderness to the calcaneus and to the midfoot region.  CI had good long term prognosis, and should fully recover over time.  However, CI had a very poor short term prognosis, with increased risk for life-long pain and disability if returned to training, or continued on Active duty.  There was no VA Compensation and Pension examination in evidence. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot injuries condition 10%, coded 5284 (other foot injuries), citing ankle dorsiflexion 15 degrees and plantar flexion 35 degrees, rated as moderate.  All Board members agreed the limitation of motion was no more than moderate, therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the ankle coded 5271.  A higher rating of 20% was not indicated in the absence of marked limited function of the foot coded 5284 (moderately severe).  There was no ankle ankylosis to support a rating coded 5270.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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 foot injuries condition.  

BOARD FINDINGS:  In the matter of the left foot injuries 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 20150622, w/attachments
Exhibit B.  Service Treatment Record

AR20170003526, 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,