RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02801
BRANCH OF SERVICE:  Army	BOARD DATE:  20150623
SEPARATION DATE:  20040123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Power Generator Equipment Repair) medically separated for chronic right foot pain.  The foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) but was authorized to perform an alternate physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right foot pain s/p talonavicular FX” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right foot/ankle pain, secondary to talus fracture” as unfitting, rated 0% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “His condition continues to worsen and negatively impact his daily activities.  His complete submission is at Exhibit A.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB – Dated 20031010 | VA* - (~5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic R Foot/Ankle Pain | 5099-5003 | 0% | Fracture R Ankle And Foot | 5010-5271 | 10% | 20040615
Other x 0 (Not In Scope) | Other x 3(equals SC, NSC & deferred)
RATING:  0% | RATING:  10%
*Derived from VA Rating Decision (VARD) dated 20040818 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Right Foot/Ankle Pain.  Review of the medical records in evidence showed that the CI broke his right foot after a transmission fell on it a year prior to accession and was treated by casting for 6-8 months.  This was not disclosed at accession.  The first record in evidence is a report dated 5 June 2002 in which the CI reported that he had stepped in a hole while running 3 days earlier.  He was treated with medications and duty modifications.  He was next seen on 11 September 2002 with recurrent pain after a car ran over his foot.  He was noted to have an old fracture on X-ray (not in evidence) as documented in a 25 September 2002 primary care note and to have full range-of-motion.  In an orthopedic evaluation on 11 October 2002, the ROM was 10 degrees dorsiflexion (normal is 20) and 45 degrees plantar flexion (normal).  He was issued orthotics and given medication.  He was seen again on 23 November 2002 complaining of pain after pushing a vehicle.  In unit games involving pulling a truck, he again strained his right foot and was seen in the emergency room on 8 May 2003.  In follow-up the next day, he was noted to have been on a profile for months.  He was issued a P3 profile and referred to the MEB.  The commander’s letter was dated 11 June 2003.  It noted that the CI’s profile had never impacted his ability to do his job (mechanic) and that he had participated in two field exercises without special allowances or signs of pain.

The narrative summary (NARSUM) was dated 1 July 2003.  The CI had a bar to re-enlistment because he was overweight.  It also noted that he had failed airborne training after a fractured ankle bone; these records were not in evidence.  He was able to bike ride and had unlimited walking.  He had not run in over a year.  He reported that his foot just gave out and that he could do little in the way of physical training.  On examination, he was tender over his instep.  An orthopedic addendum to the MEB was dated 1 August 2003, 6 months prior to separation.  The CI reported that he had fallen out (of a run) in airborne training in 2000 and was treated with a cast.  He had been issued orthotics, but reported that these aggravated his problems.  It was noted that he was barred from re-enlistment due to obesity and failure to progress on weight control.  On examination, he was tender over the top of the right foot without swelling.  There was no deformity and plantar flexion reduced to 40 degrees (normal is 45).  Extension (dorsiflexion) was normal at 20 degrees.  He was thought to have a mal-union or non-union of one of the ankle bones.  

At the VA Compensation and Pension (C&P) examination performed 5 months after separation, the CI reported that he had fractured his right foot 5 times between 2001 and 2003.  He had declined surgery.  He reported constant pain, but used no assistive devices.  Dorsiflexion was reduced to 10 degrees and plantar flexion to 30 degrees.  There was tenderness over the top of the foot, but no deformity, swelling, heat, or redness.  X-rays showed degenerative changes, but good alignment of the ankle bones.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right foot/ankle pain condition at 0%, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the right foot and ankle at 10%, coded 5010-5271 (traumatic arthritis-limited motion of the ankle [moderate]).  The limited and painful motion supports a 10% rating.  The Board found no route to a rating higher than the 10% adjudicated by the VA.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right foot/ankle pain condition coded 5271.  

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right foot/ankle pain condition, the Board unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION | VASRD CODE | RATING
Chronic Right Foot/Ankle Pain | 5271 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXX, AR20150012819 (PD201302801)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-02801