RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01120
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080111

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 “pain in the right foot and ankle” with a disability rating of 10%.

CI CONTENTION:  Additional unfitting conditions were not considered.  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 - 20071205	VARD - 20080418	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot and Ankle Pain	5099-5003	10%	History of Right Ankle and Heel Fracture	5271	10%	20080310	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Foot and Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right ankle condition began in November 2006 without specific injury.  Radiographic studies (X-rays) showed probable healing of a right calcaneus (heel bone) stress fracture.  However, the CI reinjured her right foot in August 2007 after falling in a hole during land navigation training.  An MRI showed no joint, ligament, or tendinous injury, but the right calcaneal stress fracture was not completed healed.  There was no surgical indication.

Range of motion (ROM) studies by physical therapy (PT) on 30 August and 7 September 2007 showed dorsiflexion to 10 degrees (normal 20) and plantar flexion was 45 degrees (normal 45); painful motion was present.  PT ROM studies on 27 September and 11 October 2007 showed dorsiflexion to 15 degrees and plantar flexion to 40 degrees; painful motion was again present.  The 12 October 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of instability while not wearing a CAM walker.  Physical examination noted a painful gait and stance.  There was right calcaneus, foot, tibia, and achilles tendon tenderness; calcaneus swelling; and “significant pain” with right ankle ROM; quantified measurements were not provided.  The 20 November 2007 MEB PT evaluation, 2 months prior to separation, revealed dorsiflexion to 0 degrees and plantar flexion was 30 degrees; painful motion was not addressed.

At the 10 March 2008 VA Compensation and Pension (C&P) general examination, 2 months after separation, the CI reported right ankle and foot pain and tingling with prolonged standing and walking.  Physical examination showed an antalgic gait without need for ambulatory aids or braces.  There was no right ankle or foot swelling, but there was right ankle and heel tenderness.  ROM was dorsiflexion “beyond 15” degrees and plantar flexion was “beyond 30” degrees; painful motion was present.  Right foot and ankle X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot and ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA also rated the right foot and ankle condition 10%, coded 5271 (ankle, limited motion), citing moderate limitation of motion.

The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271, limitation of ankle motion.  The panel agreed the totality of STR and VA evidence was consistent with “moderate” limitation of motion to support a 10% rating.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the calcaneus or astragalus (talus), and no astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (VASRD §4.7).  However, all panel members agreed that the impairment did not more nearly approximate “moderately severe” to support the next higher 20% rating under this code.  The panel concluded that there was no route to a rating higher than the 10% adjudicated by the PEB.  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 foot and ankle pain condition.

BOARD FINDINGS:  In the matter of the right foot and ankle pain 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004776, 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