RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05593 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060331

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Supply Administration and Operations Clerk, medically separated for “left first, second, fourth and fifth metatarsal stress fractures” with a combined disability rating of 10%.

CI CONTENTION: The CI requested review of additional conditions (PTSD and back) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 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 - 20060120	VARD - 20061109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Late Effects of Stress Fractures to Left First, Second, Fourth and Fifth Metatarsal	5279	10%	Left Foot Stress Fracture with Plantar Fasciitis	5299-5284	10%	20060615	
Tendonitis to the Left Anterior
Tibial Tendon	Cat II	Left Tendonitis of the Anterior
Tibial Tendon	5024	NSC	20060615	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Left First, Second, Fourth and Fifth Metatarsal Stress Fractures. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left foot stress fractures began in March 2005 while participating in field military activities. The 6 May 2005 bone scan revealed positive uptake or increased uptake to the base of the first metatarsal suggestive of a stress fracture. The 25 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic bilateral foot pain. Physical examination revealed gait abnormalities; moderate pronation bilaterally, abduction of the left lower extremity, and guarding against first metatarsal propulsion. During the 9 December 2005 MEB examination (recorded on DD Form 2808), 4 months prior to separation, pain was revealed over the left anterior tibial tendon, and there was weakness with left plantar flexion and dorsiflexion. At the

15 June 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported 7/10 left ankle and foot pain. The pain was aching, sharp, and cramping in nature. Physical examination revealed painful motion and tenderness of the left foot. The gait and ankle range of motion were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot stress fractures condition 10%, coded 5279 (metatarsalgia, anterior, unilateral, or bilateral) and also listed tendonitis of the left anterior tibial tendon as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable. The VA did not service connect this condition. The anterior tibialis tendon inserts into the first metatarsal bones and acts on dorsiflexion and inversion the foot. The impairment from the tendonitis was properly subsumed under the overall rating for the left foot condition IAW
§4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the left foot stress fracture with plantar fasciitis condition 10%, analogously coded 5284 (foot injuries, other), based on the STR and C&P examination, citing painful motion with tenderness.

There was no evidence of weakness or other motor dysfunction to support a rating for severe foot pain under 5279 nor moderately severe foot injury under 5282. 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 conditions.

BOARD FINDINGS: In the matter of the left first, second, fourth, and fifth metatarsal stress fractures and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended left anterior tibial tendonitis condition, the panel recommends no change from the PEB determination as Category II. 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: 

2	PD-2017-05593

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

Ill REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.