RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02379
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Aviation Resource Management Apprentice, medically separated for “left foot injury” 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 - 20090804	VARD - 20100716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Injury	5284	20%	S/P Posterior Tibial Tendon Repair, Left Ankle 	5271	20%	20091202	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Foot Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left foot condition began in late 2006 when she fell while marching and sustained an eversion injury of the left ankle.  She was initially treated conservatively for plantar fasciitis and posterior tibial tendonitis; however, an August 2007 MRI was consistent with a posterior tibial tendon (PTT) tear.  The CI underwent surgery on 28 February 2008 for PTT repair.  

Ankle range of motion (ROM) measurements performed by physical therapy (PT) on 23 March 2009, 2 months prior to separation, showed dorsiflexion (DF) of 0 degrees (normal 20) and plantar flexion (PF) of 50 degrees (normal 45), after repetition, due to mechanical limitation.  At an orthopedic follow-up visit on 26 March 2009, 2 months prior to separation, the CI was noted to have a strong posterior tibial complex and her heel was in a better, more functional position.  However, with walking she was hitting the lateral aspect of the foot (noted as lateral forefoot overload) and it was recommended she not run for several more months.  The 6 April 2009 MEB NARSUM examination noted complaints of pain with standing and walking.  The examiner recorded the CI was anticipated to be able to return to running by approximately August 2009.  Physical examination showed no tenderness of the left ankle and foot.  

At the 2 December 2009 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported limited ability to curl her toes, some loss of sensation on the plantar aspect of the foot, swelling of the foot and ankle with walking and persistent left ankle pain with flare-ups every 1 to 2 months lasting up to a week.  She was using orthotics, soft shoes and a brace.  Physical examination showed an abnormal gait favoring the left, tenderness of the mid-foot and swelling along the medial malleolus.  Strength of the left ankle was graded 4/5.  There was a mildly contracted scar below the left medial malleolus and a callous at the left fifth metatarsal pad.  Ankle ROM was DF of 8 degrees and PF of 28 degrees with painful motion.  There was no additional loss of motion with repetitive use.  Ankle X-rays showed intact surgical hardware and the joint was intact, but there was some osteopenia (bone loss) noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 20%, coded 5284 (other foot injuries).  The VA also rated the left foot condition 20%, coded 5271 (limitation of motion of the ankle), based on the C&P examination, citing “marked” limitation of motion.  Panel members agreed that the PT ROM examination proximate to separation was consistent with the “marked” limitation of motion required for the maximum 20% rating under code 5271.  The panel considered alternative VASRD ankle or foot and analogous codes, but all were less applicable and/or not advantageous to rating.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  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 left foot condition.  

BOARD FINDINGS:  In the matter of the left 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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02379.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXX

Attachment:
Record of Proceedings