RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01901
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantry, medically separated for “multiple fractures of right foot,” with a disability rating of 10%.  

CI CONTENTION:  His mobility is limited.  His 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 - 20060622	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Fractures of Right Foot	5284	10%	Residuals, Right Mid-Foot Lisfranc Fracture	5284	10%	20070126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Multiple Fractures of Right Foot.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in July 2004 after a motor vehicle accident (MVA).  During the 15 March 2006 MEB examination (recorded on DD Forms 2807 and 2808), 6 months prior to separation, the CI reported the pain in his right foot which hindered normal performance at work.  He also stated that he had loss of range of motion, slight disfigurement, and loss of feeling of his right foot.  The physical examination showed pain with inversion and palpation of the surgical scar noted on the dorsal aspect of the right foot, approximately 3.5 inches.  The CI had mild pain with heel raising of the midfoot.  The examiner also annotated that the right foot was pain free in dorsal and plantar ankle movement.  
The 15 March 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic right foot pain described as a constant ache 3/10 severity pain which caused the CI to limp when he walked.  The CI stated that his pain worsened after walking with minimum activity. The CI stated that he was unable to run or lift more than 20 pounds.  The examiner referred to the range of motion studies performed on 15 and 17 March 2006.  On 17 March 2006, physical therapy performed ROM examinations of the right and left ankle. Active ROM showed eversion of 30 degrees for both the right and left ankle, inversion was 25 degrees on the right and 35 degrees on the left, flexion was 8 degrees on the right and 10 degrees on the left and extension was 42 degrees on the right and 50 degrees on the left.  The examiner noted a diagnosis of allodynia of the right foot secondary to motor vehicle accident injury and post-traumatic arthritis of the right midfoot.  

At the 26 January 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant right foot and ankle pain.  The CI reported that stretching exercises and heat relieved the discomfort in approximately 30 minutes and there were not any flares.  The physical examination showed that the CI ambulated with normal gait and without any assistive device such as a cane.  The examiner noticed that there was no uneven shoe wear.  Radiographic evidence showed surgical hardware of the first cuneiform, second cuneiform and the base of the metatarsal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the multiple fractures of right foot condition 10%, coded 5284 (Foot injuries), citing loss of a total combined 20% range of motion in the right ankle and pain with inversion and palpation of the surgical site.  The VA also  rated the multiple fractures of right foot condition 10% coded 5284 (foot injuries, other) based on the C&P examination 3 months after separation, citing subjective reports of pain that is worse during the morning and which persists to a lesser degree as the day continues.  The panel agreed the condition met criteria for a rating of 10% under medical diagnostic code 5284, but not higher for there was not any objective findings painful or altered gait.  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 multiple fractures of right foot condition.  

BOARD FINDINGS:  In the matter of the multiple fractures of right foot 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150708, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009262, 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,					       
						      					
Enclosure