DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

From: To:

Subj: Ref:

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01473

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 17 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01473 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050331

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

CI CONTENTION:  “Review all conditions.” 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 - 20050131	VARD - 20051221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Crush Injuries	5284	10%	Bilateral Heel Contusion Fracture with Degenerative Arthritis and Pes Planus	
5010	
10%	
20051116	
	5284	10%					
Bilateral Plantar Fasciitis	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Bilateral Foot Crush Injuries. According to the service treatment record (STR) and MEB narrative summary (NARSUM), a truck drove over the CI’s feet (distal, left more than right) in March 2003. There were conflicting initial X-ray interpretations of minor fractures (non-displaced distal fourth metatarsal and proximal fifth phalanx) of the left foot, although all follow-up X-rays were interpreted as normal. Compartment syndrome was ruled out and there was no evidence of vascular, neurological, or significant soft-tissue injury. He was treated with a protracted period of non-weight bearing and activity restrictions, but suffered persistent pain that did not permit a return to infantry duty. There were STR entries of significantly limited left ankle range of motion

(ROM) initially, but this improved over time, and right ankle ROM was recorded as normal. All STR entries following resumption of full weight bearing noted a normal gait, and there was documentation of normal alignment with no foot deformity. There were no entries that documented any additional VASRD-ratable findings or diagnosis linked to a specific VASRD foot code.

The 20 October 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent bilateral foot pain (mostly in the heels) that prohibited “prolonged standing, marching, and running.” The physical examination recorded a normal gait, the absence of deformity or swelling, intact neurological findings and bilateral heel tenderness (left greater than right). There was no note of ankle limitation of motion, although measurements were not provided.

At the 16 November 2005 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported “pain in both feet and heel area aggravated by prolonged standing, walking more than half a mile.” He was not under treatment and was a full time student. The physical examination recorded a normal gait, “mild” tenderness confined to the right heel, “no pain on manipulation,” no malalignment and no swelling. The VA examiner specifically excluded all VASRD-coded foot deformities or diagnoses, although conversely diagnosed “bilateral flatfeet” in addition to “heel contusion fracture, bilateral feet.” VA foot X-rays were normal (no fracture, no pes planus) except for mild degenerative changes. There was no note of ankle limitation of motion, although measurements were not provided.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated each foot 10%, coded 5284 (foot injuries, other). The VA conferred a bilateral rating under code 5010 (arthritis, due to trauma), elaborating the absence of ratable findings on the C&P examination and stating that the rating was “based on your pain and X-ray evidence of degenerative changes.”

The panel agreed that there was no evidence to justify a rating higher than 10% under code 5271 for limitation of ankle motion (10% for “moderate” limitation). Code 5284 offers ratings (unilateral only) of 10% for “moderate,” 20% for “moderately severe,” and 30% for “severe” disability. Members agreed that the functional impairment in evidence at separation (normal gait and routine mobility preserved) could not be reasonably characterized as more than moderate for each foot; thus, no higher rating under code 5284 was supported. Analogous rating under code 5283 applicable to metatarsal fracture complications was considered, but the rating scale is equivalent to that elaborated above for the PEB’s code 5284, thus not advantageous. There was no evidence for any ratable criterion or separately coded foot diagnosis that would justify a rating higher than 10% under any other applicable code available in VASRD §4.71a. 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 condition.

BOARD FINDINGS: In the matter of the bilateral 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 there be no modification or re-characterization of the CI’s disability and separation determination.