RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00935
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Light Wheeled Vehicle Mechanic, medically separated for “right heel pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to the worsening of the foot condition, the CI also 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 - 20050714	VARD - 20060320	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Heel Pain	5299-5284	10%	Calcaneal Stress Fracture	5271-5284	20%	20060223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Heel Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right heel condition began in February 2004 after a road march.  An MRI revealed a stress fracture of the right calcaneus and X-rays revealed arthritic changes of the heel with beginning posterior spurs. 

The 16 May 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of right heel pain.  Physical examination showed an antalgic gait with use of a cane secondary to right heel pain.  There was right foot compression pain at the calcaneus and at the insertion of the plantar fascia.  There was minimal decrease in motion at the right subtalar joint and ankle joint compared to the left.  Ankle range of motion (ROM) was “essentially within normal limits” with right ankle dorsiflexion of 15 degrees (normal 20) and plantar flexion of 20 degrees (normal 45); left ankle dorsal flexion was 20 degrees and plantar flexion was 25 degrees.  Restrictions allowed use of a cane and soft shoes rather than a boot.  

At the 23 February 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported chronic pain in the right heel and Achilles tendon, exacerbated by standing or walking.  She complained of pain and numbness with prolonged standing and used a cane to walk.  Physical examination showed an antalgic gait with a mild limp to the right.  The CI was able to perform repetitive toe raises without causing increased right foot pain, but would not perform right heel walk or right heel rocks due to pain.  There was tenderness of the right malleolus and heel, and pain on manipulation of the right foot.  Dorsiflexion and plantar flexion were each 20 degrees with increased pain on repetition.  Ankle and foot X-rays showed increased sclerosis in the right calcaneus.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5299-5284 (foot injuries, other), citing an antalgic gait and tenderness at the calcaneal plantar fascia insertion.  The VA rated the right foot condition 20%, dual-coded 5271-5284 (limitation of ankle motion-foot injuries, other), based on the C&P examination, citing moderate impairment with painful and limited motion and X-ray findings of stress fracture.  

Panel members agreed the limitation of ankle motion at both the MEB and VA C&P examinations did not approach the “marked” stipulation required for a 20% rating under diagnostic code 5271.  The panel adjudged the CI’s symptoms did not approximate loss of use of the foot or the “severe” (30%) foot injury disability level under code 5284 for other foot injuries.  However, given the CI’s antalgic gait, painful ankle ROM, pain on manipulation of the foot and VASRD §4.7 (higher of two evaluations), the panel adjudged that the CI’s impairment more nearly approximated the “moderately severe” criteria in support of a 20% rating under code 5284.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right heel condition, coded 5271-5284.  

BOARD FINDINGS:  In the matter of the right heel condition, the panel recommends a disability rating of 20%, coded 5271-5284 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Heel Pain	5271-5284	20%	

AR20190007518, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.