RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2015-01782
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070828

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 “nonunion fracture of the left navicular of the foot,” with a disability rating of 10%.

CI CONTENTION:  The applicant requests consideration of all conditions.  His 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 - 20070816	VARD - 20071102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Nonunion Fracture of the Left Navicular…	5283	10%	Fracture Left Foot	5299-5283	NSC	20080710	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Nonunion Fracture of the Left Navicular of the Foot Condition.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), dated 9 July 2007, 7 weeks prior to separation, the CI injured his left foot early in basic training.  X-rays showed a fracture of the navicular bone (part of the foot between the ankle and mid-foot).  This was treated with casting and decreased activity.  The condition improved, but not sufficiently to return to full duty.  He had exhausted conservative management and declined surgical correction (to attach the two fragments to each other).  Motion of the fracture was demonstrated on X-ray, but it is not clear when this was done from the record.  Eversion and inversion of the subtalar joint (between the talus, an ankle bone, and the navicular) was reduced from pain.  The profile allowed the CI to bike for exercise.  It was not recorded that the CI was using an assistive device, cast, or brace at the time of the NARSUM evaluation, implying that he was not.  The CI did not report for the original VA Compensation and Pension (C&P) evaluation.  This was rescheduled and accomplished on 10 July 2008, over 10 months after separation.  The CI reported that he could not run due to pain, but had no occupational impairment and no limitations with standing or walking.  On examination a limp was present.  Signs of abnormal weight bearing were absent.  The navicular bone was tender to palpation.  The navicular fracture was thought to be healed, but no X-rays were obtained.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the non-union of the left foot navicular bone at 10%, coded 5283 (nonunion of the tarsal or metatarsal bones) at the moderate level of impairment.  The VA determined that the left foot fracture was not service-connected, coded 5299-5283 (analogous to nonunion of the tarsal or metatarsal bones), based on the C&P examination 10 months after separation, citing the opinion of the C&P examiner that the navicular fracture was healed.  The panel considered the evidence.  Undated X-rays showed a non-union of the navicular fracture.  The NARSUM was silent regarding tenderness and gait.  Both were abnormal on the VA examination almost one year after separation, but the examiner determined that the fracture was healed.  Eversion and inversion were noted to be reduced from pain, but no comment was made on plantar flexion (toes down) or dorsi-flexion (toes up).  The panel did not find evidence that a moderately severe impairment was present and a higher 20% rating is not supported.  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 left foot condition.  

BOARD FINDINGS:  In the matter of the non-union of the left foot navicular bone condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008893, 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