RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-00019
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, P3 Systems Organizational Initial Maintenance Technician, medically separated for “right foot status post [s/p] open reduction internal fixation [ORIF] of Chopart fracture dislocation” with a disability rating of 10%.

CI CONTENTION: No specific contention was made. 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB – 20040526	VA Rating Decision (VARD) - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot S/P ORIF ... Fracture	5283	10%	No VA Examination Proximate to Separation in Evidence*	
Persistent Right Mid-Foot Pain	Cat II		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	
* VARD of 20070322 did not service connect the condition based on nonavailability of documentation and negative findings by VA examination on 20060329 (see below, 20 months after separation).

ANALYSIS SUMMARY:

Right Foot Condition [Fracture-Dislocation with Surgical Residuals]. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained extensive metatarsal fractures (navicular, cuboid, middle and lateral cuneiforms) and dislocations (talonavicular and calcaneal-cuboid joints) of his right foot resulting in an ORIF procedure in January 2002. Serial X-rays demonstrated healing fractures and normal alignment, but there was demineralization and progressive collapse of the navicular bone. Orthopedics opined that further surgical intervention was not indicated. Provider entries in the STR over a protracted trial of rehabilitation documented normalizing ankle range of motion (ROM), but a persistent antalgic gait. The latter was consistently characterized as “slight” or “mild,” and no brace or assistive device was required. There was mention of limitation of mid-foot motion and abnormal forefoot abduction in an earlier (September 2002) orthopedic note, but this was not corroborated in later

entries. There was no STR documentation of other deformity, malalignment, persistent swelling, callosities, or other VASRD-ratable criteria.

The 19 April 2004 MEB NARSUM examination, 4 months prior to separation, documented “persistent midfoot pain” that caused pain on step-off with normal ambulation and limited standing to 15 minutes. It prohibited running, protracted load-bearing, and heavy lifting. The physical examination recorded a “mildly antalgic gait,” “mild” tenderness over the navicular bone, the absence of deformity, normal strength, and pain with manipulation (torque or resisted plantar flexion). Measured ankle ROM was dorsiflexion to 25 degrees (normal 20) and plantar flexion to 45 degrees (normal). There was no temporally probative VA examination. The delayed examination (see rating chart footnote) documented a normal gait and normal ROM without painful motion or other positive findings.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right foot condition 10%, coded 5283 (tarsal, or metatarsal bones, malunion of, or nonunion). The PEB additionally adjudicated “persistent right mid-foot pain” as a related Category II condition contributing to the primary unfitting condition but not separately ratable. This condition was intrinsic to the rated condition such that no separate rating could be supported without violation of VASRD §4.14 (avoidance of pyramiding), thus it was appropriately subsumed in the same rating. The PEB’s code 5283 for metatarsal bone injuries was a reasonable choice. It is fairly specific for the clinical pathology and offers criteria for rating of functional disability. The criterion for the PEB’s 10% rating is “moderate” disability, and the code offers additional ratings of 20% for “moderately severe” and 30% (highest) for “severe” disability. Alternate rating under code 5284 (foot injuries, other) was justifiable, although of no advantage since it offers an identical rating scale for functional disability as that for the more specific code 5283. A more favorable rating scale would be offered by analogous application of code 5299- 5262 (tibia and fibula, impairment) that provides for rating of contiguous ankle disability, but this was not justified given the greater specificity of code 5283.

Separate ratings for ankle and foot disability were not supported. The anatomic pathology was with the foot, and the ankle ROM limitation or any other criteria in evidence would not support more favorable alternate rating via any ankle joint code. There was no criterion in evidence that would support a rating higher than 10% under any alternate VASRD §4.71a foot code, with specific consideration of code 5299-5276 (analogous to acquired pes planus).

The panel agreed that reasonable doubt favored a higher rating recommendation per the above criteria of code 5283. The NARSUM, amply corroborated by STR provider notes, documented the persistence of a gait disturbance and painful ambulation. Protracted standing and sustained ambulation were restricted and this would logically pose a significant limitation of civilian occupational choices. The disability at separation was better aligned with the moderately severe (20%) criterion than with the moderate criterion, although the severe (30%) criterion was not reasonably supported. After due deliberation, considering all the evidence and conceding VASRD
§4.3 (reasonable doubt), the panel recommends a 20% rating for the right foot condition under code 5283.

BOARD FINDINGS: In the matter of the right foot condition (subsuming the related Category II condition), the panel recommends a disability rating of 20%, coded 5283 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Multiple Tarsal and Metatarsal Fractures with Surgical Residuals, Right Foot	5283	20%	

DEPARTMENT OF THE NAVY
SECRETARY  OF  TIIE  NAVY  COUNCIL  OF  REVIEW  BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 24 Jan 20
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board {PEE) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.