RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02346
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091028

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

CI CONTENTION:  In addition to the right foot condition, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20091005	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injury, Other, Due to Right Navicular Stress Fracture	5284	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began during basic training while running.  At the MEPS examination on 5 February 2009, mild asymptomatic pes planus was noted and podiatry, in March 2009, noted excessive pronation of the right foot with pes planus, tenderness of the calcaneal tuberosity, plantar fasciitis, metatarsal pain and pain with motion of the foot.  X-rays of the right foot and ankle showed mild soft tissue swelling without fracture, dislocation or bony lesion, and the mortise joint appeared normal.  A bone scan demonstrated a stress fracture at the right navicular.  
At a podiatry clinic visit on 13 April 2009, he was noted to be using crutches, and was treated with orthopedic strapping of the ankle, a foot insert for each arch and pain medication.  He was prescribed Vitamin D and calcium carbonate and provided with an AFO (multi-ligamentous ankle support).  In June 2009, X-rays of the right foot demonstrated likely pes planus and no fractures, dislocations or bony lesions involving the right foot.  The joint spaces and soft tissues were normal.  On 1 July 2009 the CI reported right foot stiffness and foot pain in the right plantar aspect; bone pain was worse with weight bearing.  On examination, there was excessive pronation of the foot and tenderness of the calcaneal tuberosity, navicular tuberosity and metatarsal, but no swelling, erythema, abnormal warmth or excessive supination.  Range of motion (ROM) measurements by physical therapy on 10 July 2009 of the right ankle were 20 degrees of dorsiflexion and 45 degrees of plantar flexion.  Painful motion was not addressed.  

The 16 July 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of right 7/10 mid foot pain and was unable to run, jump, march or stand for prolonged periods.  Physical examination showed tenderness of the right navicular and first metatarsal.  The foot was neurovascularly intact.  Examination of the skin revealed mild tinea pedis (fungus) at the plantar aspect of the right arch.  There were no scars, cysts or lesions.  There was pes planus with severe pronation and rear foot collapse on stance.  He was unable to rise up on his tiptoes of the right foot.  The ankle, subtalar and metatarsophalangeal joints had full ROMs.  There were no bony prominences at the navicular area.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5284 (foot injuries, other), citing moderate disability due to painful motion, IAW VSARD §4.59.  Panel members agreed that the disability in evidence at separation could not be reasonably characterized as more than a moderate disability using either code 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of) or code 5284.  There was no ROM limitation nor did he have any surgery that could justify a rating higher than 10%, although he did have pes planus with overpronation, mild pes planus was noted at the MEPS examination, and his pain was related to the stress fracture of the navicular bone rather than pes planus.  Therefore, since the pes planus was known to exist prior to separation, an additional rating is not warranted, especially since pyramiding (VASRD §4.14) is to be avoided.  No other applicable foot or ankle code IAW VASRD §4.71a can provide a higher rating than 10%.  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 right foot condition.  

BOARD FINDINGS:  In the matter of the right 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 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190005989, 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