RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02184
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Trainee, medically separated for “stress fracture of the left cuboid” with a disability rating of 0%.  

CI CONTENTION:  “Injury is getting worse and progressing into other areas.”  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 - 20070719	VARD - 20071105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture of Left Cuboid	5022	0%	Stress Fracture, Left Cuboid	5284	10%	20070606	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Stress Fracture of Left Cuboid.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left foot condition began in March 2007 after noting pain in the third week of Basic Training.  He exhausted all conservative means of treatment.  X-rays showed a positive uptake to the left cuboid.  

At the 6 June 2007 VA Compensation and Pension (C&P) evaluation, 1 month prior to separation, the CI reported pain of the forefoot that radiated up and down with swelling and redness.  There was increased pain and swelling with standing or walking.  Flare-ups occurred about once daily and lasted about 8 hours.  Physical examination showed a normal gait and no ambulatory aids.  Range of motion (ROM) showed dorsiflexion of 20 degrees (normal) and plantar flexion of 45 degrees (normal) without painful motion and repetition did not result in additional limitations.  There was no swelling, tenderness or deformities.   

The 15 June 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of left foot pain.  Physical examination by podiatry showed no swelling, redness or cellulitis bilaterally.  ROM measurements taken with a goniometer showed left subtalar joint inversion of 30 degrees and eversion of 10 degrees, and left mid tarsal joint eversion of 20 degrees and inversion of 20 degrees.  There was limited inversion due to pain of the left foot.  Neurovascular examination was intact.  

During the 25 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported left foot pain.  Physical examination revealed tenderness to the top of the left foot.  A 6 September 2007 X-ray of the left foot showed no sequelae from previous stress fractures.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 0%, coded 5022 (periostitis), citing slight pain with limited motion.  The VA rated the left foot condition 10%, coded 5284 (foot injuries, other), based on the C&P examination, citing foot injury resulting in moderate symptoms.  The panel noted that the approach by the PEB, using 5022 (rated according to the 5003 guidelines) allows for rating a major joint when there is non-compensable limited motion with satisfactory evidence of painful motion.  The NARSUM examination documented painful, limited motion with inversion, thereby meeting criteria for 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left foot condition, coded 5022.  

BOARD FINDINGS:  In the matter of the left foot condition, the panel recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Stress Fracture of Left Cuboid	5022	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008192, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure