RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04274
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Basic Trainee, medically separated for “right heel pain” with a disability rating of 10%.

CI CONTENTION:  Conditions continue to worsen and negatively impact daily activities.  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 - 20090619	VARD - 20091130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Heel Pain 	5284	10%	Right Heel Pain	5099-5020	NSC	20090824	
Chronic Left Elbow Pain	Not Unfitting 	Status Post Left Mid-Radial Fracture	5206	10%		
		Left Forearm Surgical Scar	7802	0%		
Chronic Left Wrist Pain		Left Wrist Pain	5215	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Right Heel Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right heel condition began in July 2008.  A bone scan in February 2009 revealed a stress fracture of the backside of the right heel.  Despite restrictive activity and anti-inflammatory medication, her right sided heel pain persisted and worsened with activity.  The 11 May 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of right heel pain exacerbated with standing greater than 5 minutes.  Physical examination (PE) revealed tenderness about the bottom aspect of the right heel.  Range of motion (ROM) measurements of the right foot or ankle were not documented.    

At the 24 August 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported right heel pain with running or prolonged walking or standing.  She endorsed painful flare-ups occurring “weekly or more often” with a duration of “less than one day.”  The PE revealed a normal gait, but there was tenderness about the right heel.  There was no evidence of painful motion, swelling, local instability, weakness or evidence of abnormal weight bearing.  There was no comment regarding ROM of the right foot or ankle.     

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right heel condition 10%, coded 5284 (foot injuries other), citing tenderness of the right plantar heel.  The VA did not service connect the right heel condition based on the C&P examination, citing a non-compensable examination.  Although considered, VASRD code 5271 (limitation of ankle motion) was not appropriate in this case given the absence of documented limitation of ankle ROM coupled with the evidence of maintaining a normal gait.  Additionally, panel members considered coding under VASRD §4.59 (painful motion), but again, there was no documented evidence of such findings.  Panel members then considered alternative ankle and analogous codes, but in the absence of ankylosis, nonunion or malunion, or an injury of moderate severity, no VASRD §4.71a applicable code would yield a rating higher than the 10% adjudicated by the PEB under code 5284.  After due deliberation 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 heel condition.

Contended PEB Conditions:  Chronic Left Elbow Pain and Chronic Left Wrist Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not separately unfitting.  Although both conditions were profiled and judged to fail retention standards, neither one was directly implicated by the commander’s performance statement.

Left Elbow.  On 17 September 2008 the right hand dominant CI suffered a left forearm radius fracture after being struck by a pugle stick during a training exercise.  On 25 September 2008, the CI underwent surgical fixation of the fractured site.  Postoperatively, the CI received continuous occupational therapy and according to the NARSUM, “with therapy she has improved, but not to the point that she is able to take a physical training test and graduate from Basic Training.”  The MEB NARSUM provider documented the following:  “[The CI] is unable to lift heavy weights or perform push-ups which would be required to graduate from Basic Training.”  Physical examination showed mild tenderness over the distal portion of her surgical scar.  Left elbow flexion was 140 degrees (normal 145) and extension was 0 degrees (normal); painful motion was present.  The VA C&P joints examination revealed left elbow flexion to 145 degrees, extension to 0 degrees, pronation to 80 degrees and supination to 85 degrees (all normal) with painful motion noted during repetitive ROM.  Although there were scant STRs, panel members extensively deliberated the CI’s fitness determination.  The panel majority concluded that the non-requirement of performing push-ups in basic training coupled with near normal ROM and intermittent left elbow pain with flexion was not at an intensity level that would significantly inter with the satisfactory duty performance as a Trainee.  Therefore, after due deliberation, the panel majority concluded there was insufficient cause to recommend a change in the PEB fitness determination for the chronic left elbow condition, so no additional disability rating is  recommended.

Left Wrist.  The MEB NARSUM examination did not document the CI’s report of left wrist pain.  Physical examination revealed left wrist goniometric measured ROM of dorsiflexion to 79 degrees (normal 70), palmar flexion to 69 degrees (normal 80), radial deviation to 20 degrees (normal), and ulnar deviation to 45 degrees (normal); painful motion was elicited with palmar flexion.  There was no edema, tenderness, joint laxity, guarding, weakness or muscle spasms and X-rays were unremarkable.  The VA C&P joints examination revealed left wrist ROM of dorsiflexion to 70 degrees, palmar flexion to 80 degrees, radial deviation to 20 degrees and ulnar deviation to 45 degrees.  All normal ROM without painful motion.  Panel members concluded the left wrist condition, without history of direct left wrist trauma and normal X-rays, was best considered a residual symptom that was subsumed by the left elbow impairment.  The commander’s statement and MEB NARSUM did not reveal performance based evidence that the CI’s left wrist condition interfered with the CI’s satisfactory duty performance at the time of separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended left wrist condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right heel condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left elbow condition, the panel majority recommends no change from the PEB’s determination as not unfitting.  In the matter of the contended left wrist condition, the panel recommends no change from the PEB’s determination as not unfitting.  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:

AR20190004359, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX:

	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.