RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201704 SEPARATION DATE: 20030617 BOARD DATE: 20130129 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-4 (99/Basic Trainee), medically separated for chronic left foot pain due to left navicular stress fracture. The CI received injuries during basic combat training, 29 October 2002 and was put in a medical hold status and was returned to military training on 14 February 2003. Soon after his return he was complaining of left foot pain and bone scan demonstrated stress fracture of the left navicular bone. The CI could not be adequately rehabilitated with treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic left foot pain due to left navicular stress fracture condition as unfitting, rated 0%, with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “Feeling medium discomfort when walking long distances & standing for a long time.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The conditions chronic left foot pain as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20030529 VA – All Effective Date 20030618 Condition Code Rating Condition Code Rating Exam Chronic Left Foot Pain due to Left Navicular Stress Fracture 5099-5003 0% Status Post Left Navicular Stress Fracture 5299-5284 10% STR .No Additional MEB/PEB Entries. 0% X 1 STR Combined: 0% Combined: 10% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. Chronic Left Foot Pain Due to Left Navicular Stress Fracture Condition. The CI developed a stress fracture of the right fibula during basic training. Although this healed, pain developed in the left midfoot and bone scan, obtained 17 March 2003, suggested stress fractures of the left foot navicular bone. The CI was treated with unsustained improvement in the left foot pain. At the MEB/narrative summary (NARSUM) evaluation, 8 May 2003, a month prior to separation, the CI reported minimal discomfort when ambulating with civilian shoes, but pain with military boots. On physical examination, mild tenderness to palpation was present over the left mid foot. No swelling or deformity was reported and arch of the foot was normal. Range-of-motion (ROM) of the foot was normal without pain or crepitus. No VA Compensation and Pension (C&P) examination was performed. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 0% code 5003, minimal and occasional pain, citing the Army pain policy. The VA rated the condition using Army MEB examination 10%, code 5282 foot injury, moderate, citing the mild tenderness on examination. Under this code, a higher rating of 20% requires moderately severe findings, not supported by the evidence in record. The Board noted the mild tenderness of the left midfoot, without crepitus, deformity or swelling; the absence of pain on orthopedic movement, and normal ROM; and the ability of the CI to ambulate without discomfort in civilian shoes. The Board unanimously agreed that that the foot condition did not rise to a 10% disability under §4.59 or §4.40. The Board was unable to find any pathway to a higher rating under any applicable VASRD code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on the USAPDA pain policy for rating left foot condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left foot pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Chronic Left Foot Pain Due to Navicular Stress Fracture 5009-5003 0% COMBINED 0% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120720, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxx, AR20130003919 (PD201201704) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)