RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00981
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “stress fractures, right second and third metatarsals” with a disability rating of 10%.  

CI CONTENTION:  .His right foot condition continues to worsen and negatively impacts daily activities.  He 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 - 20050425	VARD - 20050803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fractures, Right Second and Third Metatarsals	5279	10%	Right Foot Strain Status Post (S/P) Stress Fractures of Second and Third Metatarsals	5099-5020	10%	20050329	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Stress Fractures, Right Second and Third Metatarsals.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s stress fractures, right second and third metatarsals condition began in June 2004 in basic training.  He experienced sudden pain in the right foot and X-rays showed a stress fracture of the second metatarsal.  After 4 months the CI returned to full duty.  Two weeks into training, he again felt sudden pain in the right foot and X-rays on 12 October 2004 showed a completely healed stress fracture of the second metatarsal and a new fracture of the third metatarsal.  After 30 days of convalescent leave and 90 days of physical therapy, the CI continued to report pain in the right foot at rest, aggravated by any activity.  Repeat X-rays showed a healing fracture of the third metatarsal.  It was determined the CI would not be able to complete basic training in the foreseeable future.  The 4 February 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of right foot pain.  Physical examination showed tenderness of the mid-shaft of the third metatarsal.  

At the 29 March 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported no right foot pain at rest, but pain with standing or walking.  Physical examination showed a normal gait.  There was no tenderness, weakness, swelling, muscle atrophy, or decreased circulation of the right foot.  The CI did not wear any type of support with his shoes.  Right foot X-rays were read as normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right second and third metatarsal stress fractures condition 10%, coded 5279 (metatarsalgia), citing DoDI 1332.39 (now rescinded).  The VA also rated the stress fractures 10%, coded analogously 5099-5020 (synovitis), based on the C&P examination, citing painful or limited motion of a group of minor joints.  

The PEB assigned a 10% rating under 5279 and there is no higher rating than 10% available with this code.  There is also no higher than a 10% rating available for a group of minor joints under 5003 or any related code using 5003 rating criteria.  The panel considered other VASRD foot and analogous codes but all were less applicable.  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 right second and third metatarsal stress fractures condition.  

BOARD FINDINGS:  In the matter of the right second and third metatarsal stress fractures 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 20170211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004761, 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