NAME: XXXXXXXXXXXXXX

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

CASE: PD-2017-03954

BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090122

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 both heels” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 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 - 20071120	VARD - 20090422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Heel Stress Fractures	5099-5022	10%	Left Calcaneal Stress Fracture	5299-5284	10%	20090226	
			Right Calcaneal Stress Fracture	5299-5284	10%	20090226	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Bilateral Heel Stress Fractures. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced pain in both heels after running in basic training, and bilateral stress fractures were confirmed by X-ray and bone scan. The 7 November 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of bilateral heel pain which increased with weight bearing. Physical examination showed bilateral calcanei tenderness, pes cavus foot type, and an abnormal gait. Toe raising and heel walking were painful, but ankle range of motion (ROM) was full. A podiatry evaluation the same day recorded abnormal positioning of the feet, pes cavus, foot tenderness, calcaneal tuberosity, and plantar pain elicited by plantar fasciitis testing. At the 26 February 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported bilateral heel pain not relieved by orthotics. Physical examination showed a normal posture and gait with no evidence of abnormal weight bearing. Left ankle ROM was normal with left foot tenderness. Heel X-rays revealed a right calcaneal stress fracture with the left being occult, and ankle and foot X-rays were normal. The diagnosis was bilateral calcaneal stress fractures.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bundled bilateral heel stress fractures 10%, analogously coded 5099-5022 (periostitis), citing “non-compensable painful ROM of both ankles” and X-ray evidence of involvement in two major joints. The VA separately rated the left and right heel stress fractures 10% each, analogously coded 5299-5284 (other foot injuries), based on the STR and C&P examinations, citing moderate symptoms for each foot/heel. The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either heel/calcaneal fracture over the other. Since undue speculation would be required to conclude that impairment from either heel/foot would not have unacceptably interfered with the performance of military duties, panel members agreed each heel/calcaneal fracture was reasonably justified as separately unfitting. The panel majority agreed that while evidence of painful motion supported a 10% rating for each ankle IAW VASRD
§4.59, when considering the entirety of the STR and the C&P examination, coding analogous to 5284 (at 10% each side) was adjudged as best describing the CI’s disability condition and severity at separation. After due deliberation, the panel recommends each heel/foot be found unfitting and rated 10% each, coded 5299-5284.

BOARD FINDINGS: In the matter of the bilateral heel condition, the panel majority recommends that each foot/heel be separately adjudicated as follows: an unfitting right heel condition, coded 5299-5284 and rated 10%, and an unfitting left heel condition, coded 5299-5284 and rated 10%, both IAW VASRD §4.71a. The single voter for dissent recommends no change and did not elect to submit a minority opinion. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Heel (Calcaneal) Stress Fracture	5299-5284	10%	
Left Heel (Calcaneal) Stress Fracture	5299-5284	10%	
	COMBINED	20%	

2	PD-2017-03954

AR20200000291,

Dear XXXXXXXXXXX

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

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