RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03388
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “stress fractures bilateral calcanei” with a disability rating of 10%. 

CI CONTENTION:   In addition to the stress fractures, 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 - 20071019	VARD - 20080414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Stress Fractures Bilateral Calcanei	5099-5003	10% 	Calcaneal Stress Fracture, Right Heel	5015-5284	10%	20080207	
			Calcaneal Stress Fracture, Left Heel	5015-5284	10%	20080207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Calcaneal (Heel) Stress Fractures.  The PEB combined the right and left foot conditions under a single disability rating, coded analogously to 5003 and rated 10% with application of the US Army Physical Disability Agency pain policy.  This approach by the PEB reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.   The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left foot conditions is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated. 

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began in June 2007 after a fall.  At the 17 September 2007 MEB NARSUM examination, 2 months prior to separation, the CI’s chief complaint was documented as “bilateral heel pain.”  Her physical examination (PE) revealed a limping gait with the assistance of crutches.  Tenderness was present about both heels.  There was no evidence of redness, bruising, scars, cysts or lesions on either foot or ankle. Range of motion (ROM) of both ankles was full and painless.  Bone scans confirmed the presence of stress fractures to both heels and mid-feet.  The examiner noted the CI was not able to wear her military boots and no rehabilitation program or surgical procedure would prepare her to successfully complete military training.  

At the 7 February 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported pain, stiffness and swelling of both heels.  Her PE revealed a normal gait and mild tenderness about both ankles.  All joints were documented as having full active ROM without pain.  X-rays of both feet were normal.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral heel condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  Utilizing a dual code of 5015-5284 (benign growth; new bone - other foot injuries), the VA separately rated each foot condition at 10%, based on the C&P examination, citing foot injuries resulting in moderate symptoms and/or painful or limited motion of a major joint or group of minor joints.  

Both feet were profiled and considered to fail retention standards.  Although not listed on the CI’s profile, the orthopedic surgeon’s comment on the NARSUM of the CI’s inability to wear combat boots on either foot reasonably justified each foot as separately unfitting.  The panel then considered its rating recommendation for each foot near the time of separation.  The panel questioned the degree of present impairment given the vast difference in physical findings during the pre and post separation examinations the latter of which noted normalized X-rays and gait (without crutches).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the mere persistence of tenderness (described as mild) about the heels would not support any positive degree of impairment.  IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  Therefore, the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the bilateral foot condition.  

BOARD FINDINGS:  In the matter of the bilateral 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:

, 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.

Enclosure