RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXX	CASE: PD-2015-02421
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20030527

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “bilateral lower extremity navicular stress fractures” with a disability rating of 0%.

CI CONTENTION:  The CI requests the panel consider all conditions.  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 - 20030422		VARD - 20030601	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Bilateral Lower Extremity Navicular Stress Fractures	5099-5003	0%		Residuals, Stress Fractures of both Ankles	5299-5279	0%	20030812	
COMBINED RATING: 0%		COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Bilateral Lower Extremity Navicular Stress Fractures. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain began in January 2003 after a road march during basic training. There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow completion of initial entry training. At the 1 April 2003 MEB NARSUM examination, 2 months prior to separation, the examiner noted ongoing painful symptoms in his feet bilaterally. Physical exam showed a range of motion of the ankle joints and subtalar joints was smooth. He had zero degrees (20 normal) of dorsiflexion of the ankle joints bilaterally.   He pronated with weight

bearing. Reflexes and pulses of both feet was normal. X-rays were within normal limits and his bone scan had been positive for stress fractures of the navicular bones. At the 12 August 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported that since leaving the Army, he had much improvement, but still had some pain in his shins and knees. He made no specific complaint about his feet or ankles. Musculoskeletal physical examination showed slight tenderness over the anterior tibia of both legs, otherwise the exam was negative. Posture and gait were normal.

The PEB rated the bilateral lower extremity navicular stress fractures condition as a single unfitting condition coded 5099-5003 (analogously to arthritis, degenerative) and rated 10%. The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB. The panel first considered if the each foot, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. Both feet were profiled with no specific limitations listed. Panel members agreed that the evidence reasonably justified that the functional limitations of each foot contributed to the CI’s inability to perform his military duties and accordingly separate disability ratings are recommended.

The panel directed attention to its rating recommendation based on the above evidence. As stated above, the PEB rated the foot pain 0%, coded 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis)), citing “pain, slight, intermittent.” The VA also rated the foot pain 0% analogously coded 5299-5279 (Metatarsalgia, anterior (Morton’s disease)), based on the C&P examination 2 months after separation. There was no foot weakness which supported a rating under the diagnostic codes for weak foot (5277). There was no evidence of claw foot (5278) of acquired flatfoot (5276), or metatarsalgia, anterior (Morton’s disease) (5279. There was no tarsal or metatarsal bone malunion or nonunion (5283), or other foot injuries (5284) to support a moderate rating under their respective diagnostic codes. There was no evidence of moderate ongoing foot pain that could be analogously coded under 5399-5310 (Group X. Function: Movements of forefoot and toes) for a 10% rating. There was no other VASRD §4.71a route to a higher rating under any applicable code for either foot. 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 foot pain condition.

BOARD FINDINGS: In the matter of the right foot pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication. In the matter of the left foot pain 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 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 20151002, with attachments Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012899, 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