RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-04066
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080905

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

CI CONTENTION:  “The condition for which the above individual was discharged from service has worsened since the time/date of incident.”  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 - 20080808	VARD - 20081126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injury	5284	20%	Crush Injury to the Right Foot…	5299-5283	0%	20081017	
Bipolar Disorder, Onset Prior to Service	9432	EPTS	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Foot Injury.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s foot was run over by a vehicle in December 2007 and he sustained multiple comminuted fractures (the lateral navicular, cuneiform and cuboid) of the mid-foot, as well as a fracture of the second metatarsal and a possible small avulsion of the fifth metatarsal bone.  He underwent open reduction and internal fixation of the second metatarsal with a plate and screws, and subsequent X-rays showed good hardware alignment and complete fusion of the fracture.  
The 16 June 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of right foot pain that had never fully resolved, but was improved with rest.  He was unable to perform any portion of the Army Physical Fitness Test, and further treatment had not been recommended.  Physical examination showed a slight limp favoring the right foot and tenderness over the insertion and mid-substance of the Achilles tendon, navicular region, and second metatarsal shaft.  Right ankle ROM was normal with no instability, but foot ROM was decreased (not quantified), with painful motion.  Muscle strength was 5/5 and reflexes were 2/4 bilaterally.  The 23 June 2008 physical therapy (PT) examination showed goniometrically measured dorsiflexion to -5 degrees (normal 20) and plantar flexion to 30 degrees (normal 45), after repetition and with ROM limited by pain in all planes.  

At the 17 October 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported daily pain involving the top of the foot, but no swelling, heat or redness.  He did not use an assistive device for walking, took no medications, could stand “all day” and walk a mile and a half, and was applying for a full-time position at work.  Physical examination showed a normal gait and a 2-inch longitudinal surgical scar overlying the top of the second metatarsal area.  An X-ray showed internal fixation of the second metatarsal in excellent position with minimal degenerative spurring of the navicular and talus bones of the foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 20%, coded 5284 (foot injuries, other), citing moderately severe foot injury.  The VA rated the right foot condition 0%, analogously coded 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of), based on the C&P examination, citing the absence of moderate symptoms associated with malunion or nonunion of the tarsal or metatarsal bones.  Panel members noted that the NARSUM documented a slightly impaired gait, tenderness, and some limitation of motion but no swelling or weakness, and that the PT study did not reveal evidence of ankyloses that would meet criteria for a higher 30% rating under code 5270.  The C&P examination showed a normal gait, no use of an assistive device, and the ability to stand all day.  Thus, panel members agreed there was no evidence of a disability which met criteria for a higher rating (severe) under code 5284.  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 foot condition.  

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.71, 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.  

	PD-2017-04066

AR20190012026, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

	PD-2017-04066