RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01218
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for bilateral foot injuries with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20090204	VARD - 20090625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries due to Bilateral Foot Stress Fractures Confirmed by Imaging	5284	20%	Stress Fracture of the Right Foot	5284	10%	20090613	
			Stress Fracture of the Left Foot	5284	10%	20090613	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Foot Stress Fractures.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s non-traumatic bilateral foot condition began in 2008 while in the fourth week of basic training.  A bone scan dated 15 October 2008 showed left talus, right first metatarsal and bilateral stress fractures.  The CI was placed on 30-day convalescent leave twice without any relief of pain.  She was followed through physical therapy and treated with crutches and anti-inflammatory medication.

At the MEB NARSUM examination on 12 January 2009, one month before separation, the CI complained of bilateral foot pain.  She was unable to pass a 2-mile run or perform sit-ups due to pain; and felt she would never be able to pass her requirements. Physical examination showed an antalgic gait due to the foot pain.  Examination of lower extremities revealed bilateral foot tenderness in the arches and medial and lateral sides.  There was no evidence of foot swelling, inflammation, scars or lesions, and no neurovascular compromise.  Bilateral ankle range of motion (ROM) was “full.”  She had a flexible pes planus foot type with excessive pronation on stance and pain with a one-legged stance.  There were no bony prominences.  The examiner noted the CI was unable to carry a load in a training environment or perform her military duties due to bilateral chronic foot pain.

At the 13 June 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported pain when standing greater than 2 hours, and she avoided running and certain sporting activities to avoid the pain.  She was able to walk on a treadmill for exercise.  She had gel inserts in her shoes and was not taking any medication for pain.  Physical examination showed tenderness over several areas of each foot.  There was no evidence of weakness, fatigue, effusion, instability, heat or redness.  There was no evidence of pes planus, or of abnormal weight-bearing.  Her gait was normal.  Ankle ROM recorded dorsiflexion of 20 degrees (normal) bilaterally without pain and plantar flexion to 45 degrees (normal) without pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral condition at 20%, coded 5284 (foot injuries, other) citing bilateral full ROM, condition rated as moderate “because of preserved foot function permitting walking and standing, but with pain.” The PEB also indicated that each extremity was rated at 10%, and therefore, the rating was not bundled.  The VA rated each foot condition 10% under the same code 5284 (foot injuries, other), based on the C&P examination, citing moderate symptoms.  

The higher rating of 20% requires evidence of moderately severe disability of the foot.  The panel members considered the full ROM during the NARSUM and C&P examinations, the absence of weakness, fatigue, or swelling, and the preservation of foot function permitting walking on a treadmill and standing up to 2 hours without pain.  Pain was the primary impairing symptom.  Panel members agreed the higher rating was not warranted.  There was no higher rating under the 5284 code and no additional codes to consider.  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 bilateral foot stress fractures condition.  

BOARD FINDINGS:  In the matter of the bilateral foot 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 20170305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007410, 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