RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00851
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041010

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “left foot pain from a crush injury” with a disability rating of 10%.

CI CONTENTION:  The CI contends the injury “prevents/limits every day activities, still causes pain from time to time.”  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 - 20040728	VARD - 20060811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain from a Crush Injury	5299-5284	10%	Crush Injury of Left Foot with Surgical Repair and Retained Hardware	5284	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Foot Pain from a Crush Injury.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a crush injury with a fracture of the left foot on 29 December 2003 after a 1,000 pound trailer fell onto her foot while deployed.  This was treated by pinning the fragments together and subsequent medical evacuation to her home station.  She underwent rehabilitation and X-rays showed good approximation, but slow healing with some bone loss (osteoporosis).  In February 2004, the pin was removed, but her pain persisted.  Her recovery was complicated by a re-injury when she rolled her foot on 5 May 2004.  X-rays did not show acute findings.  The range of motion (ROM) was noted to be normal in physical therapy on 11 and 21 May 2004.  The gait was abnormal due to pain though (antalgic).  Due to ongoing pain, the CI was referred into the MEB process.  The MEB NARSUM examination was dated 10 June 2004, 4 months prior to separation, noted that the fracture was healing, but that bone loss was apparent.  Persistent tenderness was present over the fracture site.  Some atrophy was noted on the examination.  Formal ROM testing in physical therapy was accomplished 1 month later on 8 July 2004 as charted below.  There was no VA examination in evidence proximate to separation.  

Ankle ROM
Degrees	PT ~3 Mos. Pre-Sep	
	Left	Right	
Dorsiflexion (0-20)	0, (-)10, 0	10, 7, 8	
Plantar Flexion (0-45)	50, 50, 52	55, 56, 56	
Comment		No injury	
§4.71a Rating	10%	NA	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “left foot pain from a crush injury” condition 10%, coded 5299-5284 (analogous to foot injuries, other, moderate).  The VA rated the “crush injury of left foot with surgical repair and retained hardware” condition 10%, coded 5284 (foot injuries, other, moderate), based on the STR, citing retained hardware in the foot and pain and swelling.  The CI had an antalgic gait consistently recorded after the re-injury in May 2004.  The ROM was significantly reduced in dorsiflexion, although it was also less than the VA normal values on the unaffected right side.  However, on two occasions following the re-injury, the ROM was recorded as full in physical therapy.  No explanation for the reduction in ROM at the July 2004 examination was found.  The preponderance of evidence supports the 10% rating adjudicated by both the PEB and VA.  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 from a crush injury” condition.  

BOARD FINDINGS:  In the matter of the “left foot pain from a crush injury” 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 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017097, 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