RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2015-02277 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090612

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

CI CONTENTION:   The CI contends that the PEB failed to include all injuries sustained.   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 - 20090526		VARD - 20140716	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Chronic Left Foot Pain	5284	10%		No VA Examination In Evidence Proximate to Separation	
Left Calcaneal Stress Fracture	Not Unfitting						
Left Tibial Plateau Stress Fracture	Not Unfitting						
Right Tibial Stress Fracture	Not Unfitting						
Bilateral Shin splints	Not Unfitting						
Stress Reaction Left Midfoot	Not Unfitting						
Right Femoral Neck Stress Fracture	Not Unfitting						
Right Inguinal Hernia Repaired	Not Unfitting						
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Chronic Left Foot Pain. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot pain condition began in August 2008 after his IBA (individual body armor) fell onto his foot; the pain was later aggravated by a 10-mile ruck march.   X-rays were normal.   The CI was treated with crutches and medications.   He

subsequently pivoted on his foot and heard a pop. A bone scan on 27 August 2008 was suspicious for a stress fracture of the second toe on the left. A repeat X-ray on 6 October 2008 confirmed a healing stress fracture. The CI was placed in the PTRP [physical therapy rehabilitation platoon]. During the rehabilitation period, he was found to have a right inguinal (groin) hernia which was repaired on 10 November 2008. He was then placed on convalescent leave. Following recovery from the surgery, he was advanced in rehabilitation with the goal of returning to training. However, he continued to have pain in the right hip region and was found to have a possible early stress fracture of the right femoral neck on a bone scan accomplished on 14 April 2009. This was confirmed on an MRI a few days later. Incidental findings on the bone scan included a stress fracture of the left heel, a possible stress fracture of the left knee, stress changes of the left mid- foot, and bilateral shin splints. The CI was referred to orthopedics where it was noted that the CI was predisposed to stress reactions due to bilateral femoral retroversion, a growth abnormality which results in abnormal load bearing due to a mechanical derangement. The CI was referred to the MEB to prevent future injury.

The 11 May 2009 MEB NARSUM examination, 1 month prior to separation, noted complaints of ongoing pain. On physical examination, done in the orthopedic clinic, it was noted that there was not tenderness, swelling, discoloration, or decreased motion of the bilateral hips, knees, tibial shafts, ankles, and feet. Flat feet were present. The hips, knees, and ankles were stable. The formal ROM of the ankles was limited to 15 degrees dorsiflexion (toes up, normal is 20 degrees) and 35 degrees plantar flexion (toes down, normal is 45 degrees). Ankle X-rays were normal. X-rays of the feet had not been done since 6 October 2008 when the CI was noted to have a healing stress fracture of the left 2nd metatarsal. There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic left foot pain due to stress fractures of the second metatarsal, calcaneal, tibial plateau as well as midfoot stress reaction at 10%, coded 5284 (other foot injuries). The panel considered if the stress fractures of the second metatarsal and stress reactions of the calcaneus, tibial plateau, and midfoot were separately unfitting conditions. It noted that while the bone scan did show stress reactions, the NARSUM examination was essentially normal and did not support a finding that these conditions were separately unfitting. A review of the record also showed that the CI was primarily limited by foot pain, which was multi-factorial over his enlistment and the impairment from the different conditions was not severable. The evidence did not support a finding that the stress reactions of the calcaneus, tibial plateau, and midfoot were separately unfitting conditions. The NARSUM examiner documented that the ROM of the ankles was slightly reduced, but that X-rays were normal. The feet were non-tender and had normal ROM. The examination of the knees was normal. Limited ROM of the ankle, code 5271, supports a 10% rating for a moderate limitation. The panel noted that this provided no advantage to the CI and that the 5284 better described the underlying condition, a stress fracture of the 2nd metatarsal. No route to a higher rating was found. 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 pain condition.

Contended PEB Conditions: Left Calcaneal Stress Fracture, Left Tibial Plateau Stress Fracture,  Right Tibial Stress Fracture, Bilateral Shin Splints, Stress Reaction Left Midfoot, Right Femoral  Neck Stress Fracture and Right Inguinal Hernia Repaired. The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. All of the conditions were included in the L4 profile. The commander’s statement did not implicate any specific condition. All were judged to fail retention standards except the right inguinal hernia repair. However, the MEB NARSUM examination, while noting that the orthopedic conditions were medically unacceptable, also documented a normal examination for the hips, knees, ankles, and feet other than the ankle ROM. The CI was thought to have a good long term prognosis and was expected to fully recover, but was also thought to have a poor prognosis if returned to

training and continued on active duty. After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left foot pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication. In the matter of the contended left calcaneal stress fracture, left tibial plateau stress fracture, right tibial stress fracture, bilateral shin splints, stress reaction left midfoot, right femoral neck stress fracture and right inguinal hernia (repaired) conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting. 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 20150713, w/atchs Exhibit B. Service Treatment Record

AR20170012169, 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,