RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01822
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “right foot pain” with a disability rating of 10%.  

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 - 20090616	VARD - 20091207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5284	10%	Third Metatarsal Fracture, Right Foot	5284	10%	20091029	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began in March 2009 while running in his fifth week of basic training; X-rays on 21 March 2009 revealed a non-displaced right third metatarsal stress fracture.  He was treated with a controlled ankle motion walker and crutches, but was not able to return to training due to continued foot pain.  

At the 26 May 2009 MEB NARSUM examination, 1 month prior to separation, the CI complained of right third metatarsal fracture pain.  Physical examination showed an antalgic gait with pain on stance.  There was tenderness, but minimal erythema without edema along the dorsal aspect of the right third metatarsal, and pain with metatarsophalangeal joint dorsiflexion and plantar flexion.  The provider documented full ankle and subtalar joint range of motion, with a normal arch, and no right lower extremity neurovascular deficits.  An X-ray showed solid callus around the mid shaft of the right third metatarsal with a barely visible fracture line, without angulation.  

At the 29 October 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported daily right foot pain worsened by prolonged standing, and nerve damage with pain radiating up the leg.  The examiner recorded normal gait and weight bearing with no corns, calluses, edema, or flatfoot. The right foot had painful, restricted motion (not quantified) and tenderness, but right lower extremity sensation was normal with no objective evidence of nerve damage.   Foot X-rays were reported as negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5284 (foot injury, other), citing range of motion on right side consistent with the left.  The VA also rated the right foot condition 10%, coded 5284, based on the C&P examination, citing painful motion of the right foot with moderate symptoms.  
Members noted that X-rays documented good healing and improvement in gait from the NARSUM to the C&P examination, and agreed that consistent right foot metatarsal tenderness with painful motion supported a 10% rating under code 5284.  However, there was no evidence of flatfoot or foot surgery or evidence of moderately severe disability for any 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 condition.  

BOARD FINDINGS:  In the matter of the right foot pain 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 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010280, 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