RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04034
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Armored Crewman, medically separated for “left foot mid‑foot fracture” with a disability rating of 20%.

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’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 - 20060428	VARD - 20070426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Mid-Foot Fracture	5284	20%	Remote Fracture to Left Foot…	5284	10%	20070220	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Foot Mid-Foot Fracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained an IED injury of his mid- foot in September 2005.  He had navicular and comminuted fractures at the base of the third through fifth metatarsals and the third and fourth metatarsal neck.  The CI underwent an open reduction with internal fixation.

The 2 February 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of “history of left mid-foot fracture.”  The CI denied pain with ambulation and was able to perform activities of daily living.  However he was unable to run, participate in foot patrols, and climb onto and off of a military vehicles.  Physical examination revealed a normal arch with left ankle range of motion (ROM) showing dorsiflexion to 15 degrees and plantar flexion to 20 degrees and no painful motion.  There was a mild decrease in the strength of the extensor halluces longus and peroneal muscles.  The CI was able to heel-stand with an approximately 2 cm elevation of his toes and he was able to tiptoe with an approximately 5 cm raise of his heel off the floor.

At the 20 February 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported chronic daily left foot pain.  He was employed full-time as a factory worker and he felt better when ambulatory.  Physical examination revealed a bony deformity on both the lateral and medial aspects of the foot and pes planus was also noted.  There was tenderness and pain over malleolus areas.  ROM was dorsiflexion to 20 degrees and plantar flexion was 40 degrees; painful motion was present.  Sensory and motor functions were intact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 20%, coded 5284 (foot injuries, other), citing a moderately severe foot injury.  The VA rated the left foot condition 10%, also coded 5284, based on the C&P examination, citing a moderate foot injury.

The panel agreed the CI’s left foot condition, as recorded on the MEB NARSUM and VA examinations proximate to separation, did not reflect a “severe” foot injury to support a 30% rating under code 5284.  The NARSUM examination noted that the CI was ambulating without pain, and was able to dorsi and plantar flex without pain, although the ROM was decreased.  He was able to stand on his heel and toes and the profile allowed for walking, running, biking and swimming at his own pace and distance.  The panel also considered ratings under code 5283 code (malunion or nonunion of tarsal or metatarsal bones, and code 5310 (group X function: movement of forefoot and toes); however, the MEB NARSUM and VA examinations did not support a higher rating.  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 left foot condition.

BOARD FINDINGS:  In the matter of the left foot condition and IAW VASRD §4.73 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.

AR20180016608, 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.