RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00675
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “bilateral foot injuries” rated 10% each foot, with a combined disability rating of 20%.  

CI CONTENTION:  In addition to the bilateral foot condition being rated higher by the VA, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090429	VARD – 20090828 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Injuries	5284	10%	Right Foot Stress Fracture of the Calcaneus	5284	10%	20090629	
		10%	Left Foot Condition	5284	Deferred	20090629	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Foot Injuries.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began without a specific traumatic injury in 2008 during his second week of training.  Bone scan showed changes consistent with stress fractures in both feet.  The 1 April 2009 MEB NARSUM examination, one month prior to separation, noted complaints of bilateral foot pain, predominantly in the right, with left mild intermittent pain.  Physical examination showed normal ambulation.  The left foot was not tender but there was right foot plantar tenderness without swelling.  Bilateral ankle range of motion (ROM) was dorsiflexion of 5 degrees (normal 20) and plantar flexion of 45 degrees (normal).  X-rays in April 2009 showed bilateral sclerosis in the calcaneus consistent with healing stress reactions. A week later during the MEB examination (recorded on DD Forms 2807-1 and 2808, the CI reported bilateral foot pain and physical examination showed bilateral heel pain.  

At the 29 June 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported bilateral foot pain, and especially after activities, and especially in the right foot.  He used inserts for both feet.  Physical examination showed a normal gait without tenderness in the hindfoot, forefoot or arch of either foot.  There was no swelling, loss of arch, bunion, hallux valgus, hammertoes, pes cavus, or other deformities of the feet.  Right ankle ROM was dorsiflexion of 25 degrees and plantar flexion of 45 degrees, with no loss after repetitive use.  X-rays were normal except for mild hallux valgus bilaterally.  During the 29 September 2009 VA C&P joints examination (addendum), left ankle dorsiflexion was 25 degrees and plantar flexion was 45 degrees, with no loss after repetitive use.  There was no clinical examination of obvious hallux valgus of either foot.  The 19 May 2010 C&P examination, 12 months after separation was a medical records review with an expert opinion.  The physician opined that the hallux valgus had existed prior to service and also that the painful feet conditions were not service connected (NSC).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left foot condition 10% for each foot, coded 5284 (foot injuries, other), citing moderate symptoms.  The VA rated the right foot condition 10%, coded 5284, based on the C&P examination, citing moderate symptoms and deferred the left foot rating.  

The PEB clearly indicated that each foot was separately rated at 10% for moderate symptoms.  There was insufficient evidence to show that either foot rose to the “moderately severe" disability range for the next higher rating.  Although the pre-separation NARSUM examination noted 5 degrees of dorsiflexion in each ankle, which may be considered to warrant a 20% rating for each side, that examination was considered an outlier and the normal gait and post-separation VA examination refuted that degree of ankle disability by reflecting bilateral ankle dorsiflexion measurements of 25 degrees.  The panel considered alternative VASRD foot and ankle analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right and left foot conditions.  

BOARD FINDINGS:  In the matter of the right and left foot conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

AR20190007493, 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.