RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03587
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, Basic Enlisted Airman, medically separated for “right calcaneal stress fracture” and “left calcaneal stress fracture,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The bilateral foot condition continues to worsen and negatively impact daily activities.  Review of additional conditions not identified by the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB) was also requested.  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 - 20090106	VARD - 20090722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Calcaneal Stress Fracture	5273	10%	Residuals, Bilateral Calcaneal Stress Fractures	5299-5273	10%	20090722	
Left Calcaneal Stress Fracture	5273	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right and Left Calcaneal Stress Fractures.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right and left calcaneal stress fractures were diagnosed by bone scan on 10 June 2008 during basic training, and confirmed on X-rays in July 2008.  The CI was placed on convalescent leave.  At the follow-up evaluation on 30 October 2008, the CI complained of continued bilateral heel pain.  Physical examination showed the CI ambulating with crutches.  There was tenderness on palpation of both heels with painful motion of the foot and decreased foot flexion and extension.  Diagnostic imaging showed findings consistent with healing bilateral calcaneal stress fractures, with no completed fractures.  The 10 November orthopedic evaluation noted continued bilateral heel pain, and X-rays showed sclerotic areas in both calcaneal bones which represented still healing stress fractures.  The specialist indicated it was likely to take an additional 3-6 months of activity restriction for healing.  The 3 December 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of continuing use of crutches for the past 5 months and 3/10 pain in her bilateral hips, shins and heels while sitting or ambulating with crutches.  Physical examination showed full range of motion of both ankles with normal appearing feet.  Foot motion was normal without painful motion.  Each foot demonstrated a positive tarsal Tinel’s sign.  

At the 22 July 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported chronic bilateral pain and stiffness in her feet.  Physical examination showed gait was erect and non-ataxic with a tendency to walk on the balls of the feet secondary to pain and there was discomfort in the heels and arches.  There was tenderness on the bottom of both feet especially around the heels and the arch areas, and also at the Achilles tendon calcaneal insertion.  There was no swelling, redness, or warmth, and no particular painful movement associated with manipulation of foot joints.  There was pain and fatigability on repetitive motion.  X-rays were essentially negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and the left calcaneal stress fractures 10% each, coded 5273 (os calcis or astragalus (talus), malunion), citing bilateral lower extremity pain despite restricted activity and use of crutches for 5 months, and significant restrictions that prevented [the CI] from completing training.  The VA rated the calcaneal stress fracture condition as a bilateral condition (included the other foot into one rating) 10%,with the same coding, based on the C&P examination, citing moderate deformity of the os calcis or astragalus, and objective evidence of tenderness.  There was no marked deformity, moderately severe malunion or nonunion, marked ankle limitation of motion, or moderately severe foot injury signs and symptoms for any rating higher than 10% for either foot.  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 or left calcaneal stress fracture conditions.  

BOARD FINDINGS:  In the matter of the right and left calcaneal stress fracture conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudications.  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.  

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03587.

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.