RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03216
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Light Wheeled Vehicle Mechanic, medically separated for “chronic stress fracture, left foot” with a disability rating of 0%.

CI CONTENTION: “Still having problems with the left foot, which is now causing secondary medical conditions in the left leg, left hip.”  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 - 20060908	VARD - 20080116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Stress Fracture, Left Foot	5099-5022	0%	Stress Fracture Fourth Metatarsal Left Foot	5099-5022	0%	20070810	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Left Foot Stress Fracture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left foot condition began in November 2005 while running and marching during basic training.  A bone scan on 8 March 2006 showed a healed left fourth metatarsal base stress fracture and mild uptake at the left first metatarsal base consistent with a minor stress fracture; mild diffuse uptake about the left knee was consistent with overuse but not a stress fracture.  An X-ray on 20 June 2006 showed no evidence of stress fractures, but the CI reported persistent pain, despite conservative treatment, and was placed in a walking cast. 
The 20 July 2006 MEB NARSUM examination, 2 months prior to separation, noted the CI was not able to walk normally on her left foot.  She could not march or run, and push-ups exacerbated foot and leg pain.  Physical examination showed left leg tenderness localized in the tibial shaft but no swelling, redness, deformity or warmth of the feet.  The examiner also noted tenderness along the lateral tarsometatarsal joints as well as the first through fifth metatarsals “in the shaft into the base, the lateral cuneiform and cuboid.” Foot motion was “normal” without pain and there was no loss of “protective sensation” in the feet.  Neurovascular function was intact, and further diagnostic studies and surgery were not indicated.

The 10 August 2007 C&P examination, 11 months after separation, noted CI complaints of a constant, dull ache in the left midfoot with tingling along the arch and occasional swelling along the dorsum.  She had monthly flares of severe stabbing pain, and walking or standing caused shooting pain.  The CI used bilateral arch supports in her shoes and stated her foot problems also caused left leg and knee pain.  After service discharge, she worked for a dry cleaning service for 3 days, but quit since it involved prolonged standing, and had not worked since that time.  She reported no hospitalization, emergency room visits or periods of incapacitation, and denied any problems accomplishing chores.  Shopping exacerbated the foot pain and she had a mild ache while showering.  Physical examination showed erect posture and normal gait, and no left foot swelling, redness or tenderness.  There was no functional limitation with standing or walking, and no evidence of painful motion, weakness or instability.  A 13 August 2007 bone scan showed increased activity in the mid right foot and no abnormality identified in the left foot.  The diagnosis was “resolved left foot stress fracture, fourth metatarsal.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 0%, analogously coded 5099-5022 (periostitis.)  The VA rated the left foot condition 0%, analogously coded 5099-5022, based on the C&P examination, citing no symptoms and no objective evidence of painful or limited motion.  While the STR documented stress fractures of the first and fourth metatarsals, members agreed these had healed prior to separation.  The MEB NARSUM noted the presence of left foot tenderness and inability to walk normally due to left foot pain, but the panel concurred that there was no evidence of limited or painful motion (4.59) to warrant a 10% rating.  Additionally, the C&P examination noted a normal gait with no functional limitations in standing or walking.  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 left foot condition.  

BOARD FINDINGS:  In the matter of the chronic left foot stress fracture 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 20170510, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008980, 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