RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02567
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080716

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 “foot injuries, other:  left foot” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20080701	VARD - 20081202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries, Other: Left Foot	5284	10%	Chronic Left Heel Achilles Tendinitis and Status Post
Stress Fracture of Left Heel	5299-5271	0%	20080912	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot injury condition began in January 2008 with no specific injury or trauma.

The MEB NARSUM examination on 6 June 2008, 1 month prior to separation, noted complaints of chronic left heel pain secondary to the calcaneal stress fracture.  Physical examination showed no swelling or obvious foot deformity, but tenderness of the heel.  Bilateral foot and ankle muscle strength was 5/5.  A 20 May 2008 X-ray showed a left calcaneal (heel) stress fracture.  Physical therapy performed goniometric-bilateral active range of motion (ROM) documenting dorsiflexion to 10 degrees (20 normal) and plantar flexion to 40 degrees (45 normal); painful motion was not addressed.

At the 12 September 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported intermittent aching or sharp pain elicited with physical activity; however, no limitation with standing or walking.  She did not wear corrective shoe.  Physical examination revealed upper calcaneus at the distal aspect of the Achilles tendon tenderness.  Bilateral ROM was 20 degrees and plantarflexion was 45 degrees.  Repetitive use did not limit ROM due to pain, fatigue, weakness, lack of endurance, or incoordination.  A left heel X-ray revealed normal calcaneus without fracture or lesion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot injury condition 10%, coded 5284 (foot injuries, other), citing a ‘moderate’ injury.  The VA rated the left foot injury condition 0%, analogously code 5299-5271 (ankle, limited motion), based on the C&P examination 2 months after separation, citing mild Achilles tendonitis with normal ROM.

All panel members agreed the left foot injury was no more than moderate; therefore supporting a 10% rating coded 5284 (foot injuries, other).  There was no acquired flatfoot, weak foot, claw foot, to support rating under their respective codes 5276, 5277, or 5278.  There was no 5279 metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral (5279).  There was no tarsal or metatarsal bone malunion or non-union under 5283.  There was no ankle limitation of motion to support a 10% rating (5271).  There was no ankle ankylosis to support a rating coded 5270.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to the CI’s rating.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for the left 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 left foot injury condition.

BOARD FINDINGS:  In the matter of the left foot injury condition 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013324, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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