XXXXXXXXXXXXXXX. 

Dear  XXXXXX:

Accept Denial
	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.
 
	A copy of this decision has been provided to the counsel you listed on your application; 

Accept Retirement
I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 20% effective the date of your medical separation for disability with [severance pay] [Reserve retirement].  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation [minus the amount of severance pay you were previously paid at separation].
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (TAPD-ZB / Mr. Brower), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].

Accept Modification
The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% 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 and to the counsel you listed on your application; 

Accept TDRL – No Change
	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at ZZ% disability for six months effective the date of your original medical separation for disability with [severance pay] [Reserve retirement] and then following this six month period no re-characterization of your separation or modification of the permanent disability rating of 20%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period will result in an adjustment to your pay providing you ZZ% retired pay for six months from the date of your original medical separation and then no re-characterization of your separation or modification of the permanent disability rating of 20% following the constructive six month TDRL period. 

	The accepted DoD PDBR recommendation has been forwarded to the 
Army Physical Disability Agency for required correction of records and then to the 
U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].

Accept TDRL - Modification
	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at ZZ% disability for six months effective the date of your original medical separation for disability with [severance pay] [Reserve retirement] and then following this six month period your disability rating should be modified to 20%  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.  

The constructive TDRL period will result in an adjustment to your pay providing you ZZ% retired pay for six months from the date of your original medical separation. This will not result in any change to 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. 

	The accepted DoD PDBR recommendation has been forwarded to the 
Army Physical Disability Agency for required correction of records and then to the 
U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX. 	CASE:  PD-2017-05726
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Field Artillery Automated Tactical Data System Specialist, medically separated for “foot injuries, other,” rated 10% for each foot, with a combined disability rating of 20%. 

CI CONTENTION:  “Review all conditions.”  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 - 20090603	VARD - 20091106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries…	5284	10%	Residual of Stress Fracture Right Foot and Ankle	5299-5020	10%	20090820	
		10%	Residual of Stress Fracture Left Foot and Ankle	5299-5020	10%	20090820	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Foot Injuries.  According to the service treatment record and MEB narrative summary (NARSUM), the CI developed pain in the bilateral lower extremities in September 2006 during basic training, but was able to graduate and did well until February 2008, when symptoms returned in the lower bilateral ankles and feet during physical training and ruck marches.  Imaging showed stress reactions throughout the bilateral lower extremities.  A bone scan on March 2009 showed overuse injury of the distal femurs, proximal tibias, anterior tibial cortex bilateral ankles and first metatarsophalangeal joints (MTJ), bilaterally. 
During the 18 March 2009 MEB orthopedics consultation, 6 months prior to separation, the CI reported the worst pain was on the balls of his feet, exacerbated by running.  He also had debilitating pain after walking a half-mile.  Physical examination revealed mild tenderness over the anterior tibias, and full range of motion (ROM) of the knees, ankles and toes with 5/5 strength.  There was no notable tenderness of the bilateral knees, ankles or feet, and no evidence of knee or ankle instability.  

The 31 March 2009 MEB NARSUM examination, 7 months before separation, noted CI complaints of bilateral lower leg pain.  Physical examination showed mild tenderness over the right distal anterior tibial shaft, but no tenderness on the left.  There was no swelling or redness about the ankles or feet, and anterior drawer testing of both ankles was negative.  Active bilateral ankle dorsiflexion was to 20 degrees (normal) and plantar flexion to 45 degrees (normal), with pain at the end ranges of motion.  There was full ROM of all toes with pain on repetitive motion of the feet.  There was no effusion, tenderness, bruising or locking of the ankles, and gait was normal with no lower extremity atrophy.  Strength was 5/5, reflexes were normal, and sensation intact.  

At the 20 August 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported flare-ups of burning pain associated with weakness and fatigue when he marched or carried a rucksack.  He did not use an assistive device and denied incoordination, spasm or limitation of motion.  Physical examination showed mild tenderness of the bilateral plantar fascia and at the tip of the great toes.  There was no unusual shoe wear, and ankles showed normal ROM and stable ligaments.  There was no pain, tenderness, fatigue or other symptoms with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated foot conditions 10% each, coded 5284 (foot injuries), citing moderate foot injury with preserved ability to ambulate with pain.  The VA also rated the foot conditions 10% each, but analogously coded 5299-5020 (synovitis), based on the C&P examination, citing painful or limited motion of a major joint.  Members agreed that the right and left foot conditions were equally symptomatic, with examination findings essentially the same in both, and showing bilateral ankle and foot stress fractures and non-compensable ROM.  Radiographic studies documented bilateral pathology and the MEB NARSUM documented painful motion of each foot and ankle.  According to VASRD §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint or group of minor joints, and members agreed the CI’s persistent right and left foot pain interfered with work.  However, the NARSUM examination showed normal gait, no lower extremity atrophy, intact neurovascular functions, and no increased symptoms with repetitive ROM, and thus the panel adjudged that there was no evidence of moderately severe foot disability to warrant a higher 20% 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 right and left foot conditions.

BOARD FINDINGS:  In the matter of the right and left foot injuries 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.