RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03242
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060602

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Animal Care Specialist, medically separated for “stress fracture, right third metatarsal [foot]” with a disability rating of 10%.  

CI CONTENTION:  Her feet problems continue to worsen and negatively impact daily activities.  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 - 20060417	VARD - 20070409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fracture, Right Third Metatarsal	5299-5279	10%	Right Foot Plantar Fasciitis and Stress Fracture of Third Metatarsal	5284	0%*	20061005	
Leg Pain	Not Unfitting	Right Lower Extremity Tibial Stress Fracture, Shin Splints	5399-5312	0%	20061005	
		Left Lower Extremity Tibial Stress Fracture, Shin Splints	5399-5312	0%	20061005	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	
*VARD dated 20090307 retroactively changed the right foot rating to 5279 at 10% based on appeal and examinations in November 2007 and February 2009.  

ANALYSIS SUMMARY:  

Stress Fracture, Right Third Metatarsal.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began in late 2005 during basic training, with no history of injury or trauma to her foot.  Due to continued pain she was evaluated and diagnosed with a stress fracture of her right third metatarsal substantiated by X-ray and bone scan findings.  

During the 2 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI complained of constant moderate right foot pain.  Physical examination showed a normal arch, with a normal heel to toe walk.  Sensory, reflex, and motor testing were normal.  The 2 March 2006 MEB NARSUM examination, 3 months prior to separation, noted symptoms that were made worse with any impact activities or with prolonged standing, ambulation, or walking on uneven terrain.  Physical examination of the right foot showed no edema, erythema, or ecchymosis.  There was full active range of motion (ROM) of the right ankle.  There was increased tenderness about the third metatarsal with no crepitus or deformity noted.  There was also increased pain with squeezing of the metatarsal heads.  

At the 5 October 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported a right foot fracture and plantar fasciitis with pain mainly at the plantar forefoot, moderate every day when up on her feet.  She also complained of bilateral ankle sprains and shin splints with constant bilateral anterior leg pain, aggravated by sitting, walking, and standing, without pain effecting the joint range of motion.  Physical examination showed normal posture and gait, with no signs of uneven weight bearing.  There was tenderness on the dorsum of the right forefoot.  Toe motion was normal.  Bilateral ankles were non-tender and had normal ROM without pain.  With repetition of motion, there was no loss of motion secondary to pain, weakness, or lack of endurance.  Both anterior tibias were slightly warm to the touch and tender.  There were no other deformities; “Does not affect joint range-of-motion of any joints.”  The diagnosis was stress fracture of the third metatarsal of the right foot and right foot plantar fasciitis, as well as bilateral tibial stress fractures.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the stress fracture, right third metatarsal condition 10%, coded analogously to 5279 (metatarsalgia), citing a radiographically portrayed stress fracture.  The VA rated the right foot and third metatarsal condition 0%, coded 5284 (foot injuries, other), based on the C&P examination, citing a non-compensable evaluation in the absence of moderate symptoms associated with foot injury.  On appeal, based on continued right foot symptoms and more remote VA examinations (November 2007 and February 2009), including a diagnosis of metatarsalgia, the VA increased the right foot rating to 10%, coded 5279, effective the day after separation.  

There was no right foot arch abnormality for alternative coding under 5276 (flatfoot, acquired) or 5278 (claw foot [pes cavus], acquired); no metatarsal bone malunion or nonunion (5283); and insufficient evidence of moderately severe foot injury (5284) for any rating higher than the 10% adjudicated by the PEB under any alternative coding.  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 stress fracture, right third metatarsal condition.  

Contended PEB Condition:  Leg Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The NARSUM did not indicate right or left leg pain.  Leg pain was not profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the stress fracture, right third metatarsal condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended leg pain condition, the panel agrees that it cannot recommend it for additional disability rating.  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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006237, 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