RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01638
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for chronic right foot and ankle pain due to “multiple shrapnel fragments to his lateral lower right leg from a RPG blast with open fracture of the right calcaneus and closed fracture of the cuboid, talus, distal fibula and fifth metatarsal” with a disability rating of 10%.  

CI CONTENTION:  “I was never looked at for other issues that would have made me unfit for service.”  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 – 20080804	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Shrapnel Fragments to Right Lower Extremity… 	5284	10%	No VA Examination Proximate to Separation	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Multiple Shrapnel Fragments to Right Lower Extremity…  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s HUMVEE was hit by an RPG on 14 June 2007, sending shrapnel into his distal right anterior thigh, lateral leg, and foot.  Initial X-rays on 16 June 2007 noted no significant fracture of the calcaneus, but small fractures of the base of the cuboid and fifth metatarsal could not be excluded.  At the time of surgery on 17 June 2007 for shrapnel debridement, the surgeon noted a “mainly evulsion (sic) loss of the lateral calcaneus with extension up into the cuboid.”  Subsequent imaging revealed fractures of the right calcaneus, cuboid, talus, distal fibula, and fifth metatarsal.  There was no other abnormality of the tibia or fibula.  There were retained shrapnel fragments in the soft tissues of the leg, ankle, and foot.  The multiple right lower extremity (RLE) wounds due to shrapnel and surgical debridement healed without complications.  

During the 3 March and 18 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 and 9 months prior to separation, the physical examination was normal for the lower extremity, but abnormal for the foot.  At the 19 June 2008 MEB podiatry consult, 6 months before separation, the CI reported right ankle pain with pain of the lateral foot.  Physical examination showed no swelling of the lower leg, ankle, or foot.  There was normal foot posture with weight bearing.  There were over 35 scars of the RLE noted from the right knee to the foot.  Range of motion (ROM) of the ankle, subtalar, and metatarsal joints was normal.  Weakness of eversion of the right ankle was noted, consistent with “probable peroneal weakness.”  There was significant loss of sensation at the lateral aspect of the leg with paresthesias distal to the right ankle.  There was tenderness of the distal fibula as well as the lateral aspect of the ankle and foot.  

The 20 June 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic right ankle pain and swelling with standing for long periods.  The CI reported that he “rolled his ankle” inward an average of once monthly, with pain and swelling for approximately 2 days afterwards.  He did not report pain or symptoms of any other part of the right lower extremity.  Physical examination showed pain with ankle movement in all planes of motion.  There was no swelling or discoloration.  The CI was able to heel raise fully with ankle pain.  Strength of the extensor hallucis longus, peroneals, and anterior tibialis was graded 5/5 bilaterally.  The RLE was neurologically intact.  There was normal ROM of the ankles, subtalar joint, and metatarsal joint.  The remainder of the physical examination was noted to be normal.  

At the 24 June 2008 physical therapy ROM evaluation for the MEB, 6 months before separation, the CI reported a constant 1/10 pain level increased with walking and standing.  Right ankle ROM (after three repetitions) was dorsiflexion of 20 degrees (normal) and plantar flexion of 42 degrees (normal 45).  Ankle stiffness throughout ROM was noted.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right foot and ankle pain [secondary to multiple shrapnel fragments to the lateral lower right leg] 10%, coded 5284 (other foot injury), citing moderate foot injury.  The panel noted that the PEB adjudication was broad and indicated “multiple shrapnel fragments to his lateral lower right leg” with fractures of the ankle and foot causing residual “chronic right foot and ankle pain.”  Therefore the panel considered all possible ratings for the CI’s RLE injuries due to the explosion.  

A 10% rating was supported for the ankle and foot injuries under the 5284 code.  Though not specifically addressed in the MEB examinations, there was no indication that the CI had an abnormal gait, used any assistive device, or required a brace for the right ankle.  The panel agreed this evidence did not support characterizing the foot condition as moderately severe for a higher rating under 5284.  There was no limitation of dorsiflexion or plantar flexion that supported a higher rating for limitation of motion (5271).  The panel also considered if rating as analogous to 5262 (tibia/fibula impairment) was appropriate in this case; however, there was no evidence that any of the CI’s multiple ankle and foot fractures healed with non-union or malunion, so this approach was abandoned.  There was no ankylosis of the ankle or tarsal joints (5270, 5272) or nonunion or malunion of the tarsal or metatarsals (5283) for higher rating under these codes.  

The panel considered if additional rating was warranted for either peripheral nerve injury or muscle injury due to the RPG blast.  The podiatrist noted some peroneal weakness of the ankle in eversion.  However, the MEB NARSUM examiner did not note any weakness, suggesting any weakness was at most of mild functional significance, and the CI was not using any assistive devices or braces.  The podiatrist also noted sensory loss of the lateral aspect of the right leg and paresthesias of the foot.  However, there was no evidence that the sensory findings caused any functional impairment.  Therefore, the panel does not recommend additional rating for either peripheral nerve injury or muscle injury.  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 chronic right ankle pain [due to multiple shrapnel fragments to the lateral lower right leg] condition.  

BOARD FINDINGS:  In the matter of the chronic right ankle pain [due to multiple shrapnel fragments to the lateral lower right leg] 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180005411, 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