RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00784
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090409

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 “foot injury due to stress fracture” with a disability rating of 10%.  

CI CONTENTION:  The condition is still symptomatic.  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’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 - 20090402	VARD - 20091124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injury due to Stress Fracture 	5284	10%	Left Foot Stress Fracture	5284	10%	20090613	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Foot Injury due to Stress Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left foot condition began in September 2008 after stepping in a hole during a ruck march.  Radiographic studies showed a stress fracture of the second left metatarsal (the long bony ray in the foot).  The 3 February 2009 physical therapy ROM study, 2 months prior to separation, showed normal gait and full, painful, range of motion (ROM) of the ankle.  The 6 February 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), was noted to be normal.  

During the 24 March 2009 MEB NARSUM examination, 2 weeks prior to separation, the CI complained of persistent pain with prolonged walking, marching or running.  The physical examination showed a tender second metatarsal.  Motor function, gait and stance were normal.  X-rays showed good callous formation (indicative of a healed fracture).  Left ankle dorsi-flexion was limited to 10 degrees (normal 20) and there was pain with movement of the second toe.  There was otherwise painless and full ROM of the foot and ankle.   

At the 1 June 2009 VA Compensation and Pension (C&P) general evaluation, 2 months after separation, the gait was abnormal, without further detail.  Two weeks later at the 13 June 2009 C&P foot evaluation, the CI reported daily pain and limitations in walking.  On physical examination, the left second metatarsal was mildly tender.  The ROM was normal and painful motion was not documented.  The foot was normal in appearance.  X-rays were consistent with a healed fracture and he was assessed as having a healed fracture of the second metatarsal.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5284 (foot injuries, other), citing moderate disability.  The VA also rated the left foot condition 10%, coded 5284, based on the C&P examination 2 months after separation, citing moderate symptoms.  The panel considered the evidence.  Painful and limited motion were recorded on some examinations but on others motion was normal and/or painless.  The gait was noted to be normal on several examinations prior to separation.  The general C&P examination noted an abnormal gait, but without further elaboration.  The evidence did not support an impairment greater than moderate using the 5284 code.  The panel also considered the code 5271 (limited motion of the ankle), but most examinations supported a 0% rating and none supported more than a 10% rating.  After due deliberation, considering all of 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 left foot condition.  

BOARD FINDINGS:  In the matter of the left foot condition 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004905, 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,					      
Enclosure