RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00031	
BRANCH OF SERVICE:  Army	 date of SEPARATION:  20071125		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-6, Combat Engineer, medically separated by the Informal Physical Evaluation Board (PEB) for “chronic left foot pain, status post chevron bunionectomy, 5th metatarsal osteotomy, proximal interphalangeal joint arthrodesis of digits 2 and 3 and proximal interphalangeal joint arthroplasty on the forth toe” and “chronic right foot pain secondary to hallux valgus deformity,” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  The applicant’s complete submission is at Exhibit A.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44.  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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVICE PEB –20070907	VARD - 20080819	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain	5279	10%	Chronic Left Foot Condition	5279-5280	10%	20071213	
Chronic Right Foot Pain 	5280	0%	Right Foot Strain (Hallux Valgus)	5280	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:   

Left Foot Pain.  On 26 August 2005, he had surgery on the left foot.  Subsequently, three other surgical procedures were done on the left foot.  After four surgeries, he continued to have significant problems with his left foot, and a Medical Evaluation Board (MEB) was initiated.  The MEB orthopedic physical examination (PE) was on 27 June 2007.  The CI reported that he was unable to run, jump, march, or do prolonged standing.  He was unable to walk on uneven terrain, and had trouble with weight-bearing activities.  Focused PE of the left lower extremity (LLE) revealed some tenderness to palpation (TTP) of the left foot, and limited range-of-motion (ROM) of all five toes of the left foot.  There was full ROM of both ankles and both subtalar joints, without pain or crepitus.  The narrative summary (NARSUM) diagnosis for the left foot was: Symptomatic metatarsalgia (3rd greater than 2nd and 4th), sub-metatarsal heads of the left foot.

The CI was medically separated from service on 25 November 2007.  Eighteen days later, on 13 December 2007, he had a VA Compensation and Pension (C&P) exam.  He reported pain, swelling, and stiffness of the left foot.  The pain was described as constant and throbbing.  The CI denied any heat, redness, fatigability, weakness, lack of endurance, or other left foot symptoms.  On PE, he was in no distress and his gait was normal.  On focused PE of the left foot, there was TTP, but no objective evidence of swelling, weakness, instability, or painful motion.  Muscle motor strength and deep tendon reflexes (DTRs) were normal.  X-ray showed moderate pes planus deformity, and evidence of post-operative changes, but no other significant abnormality.

The Board directed attention to its rating recommendation based on the evidence.  The Army PEB and the VA chose very similar coding options for the left foot condition, and both rated it 10%.  The PEB used VASRD diagnostic code (DC) 5279 (Metatarsalgia).  The VA chose DC 5279-5280 (Metatarsalgia, with hallux valgus).  The Board determined that, IAW VASRD §4.71a, DC 5279 was appropriate for the left foot condition, and a 10% rating was warranted.  The Board tried to find a path to a higher rating, using other VASRD codes that could be applied to the left foot condition.  There was no path to a higher rating since there was insufficient evidence of a seriously disabling bone, joint, or other left foot abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the left foot condition.  It is appropriately coded 5279, and meets criteria for the 10% rating level, IAW VASRD §4.71a.

Right Foot Pain.  The CI also complained of right foot pain.  At the June 2007 MEB orthopedic PE, there were digital contractures 2-5 of the right foot, with hallux valgus and pes planus noted.  The PE of the right foot was otherwise normal.  The NARSUM diagnosis for the right foot was: “Symptomatic hallux valgus” and “Symptomatic hammertoes of digits 2-5.”

At the December 2007 C&P exam (18 days after separation), the CI reported pain and swelling of the right foot.  The pain was described as constant, and 4/10 (four out of ten) in severity.  He denied any heat, redness, stiffness, fatigability, weakness, lack of endurance, or flare-ups of foot joint disease.  On PE, he was in no distress and his gait was normal.  The focused PE of the right foot showed no objective evidence of painful motion, swelling, tenderness, weakness, instability, or abnormal weight-bearing.  Muscle motor strength and deep tendon reflexes (DTRs) were normal.  Muscle tone was normal, and there was no muscle atrophy.  X-ray of the right foot was unremarkable.  

The Board directed attention to its rating recommendation based on the evidence. The Army PEB and the VA chose identical coding and rating options for the right foot condition.  Both used DC 5280 (Hallux valgus).  The Board determined that, IAW VASRD §4.71a, DC 5280 was appropriate for the right foot condition, and a 0% rating was warranted.  There was no path to a higher rating since there was insufficient evidence of a seriously disabling bone, joint, or other right foot abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the right foot condition.  It is appropriately coded 5280, and meets criteria for the 0% rating level, IAW VASRD §4.31, and §4.71a.  
BOARD FINDINGS:  In the matter of the Chronic left foot pain, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the Chronic right foot pain, and IAW VASRD §4.31, and §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.  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160005100   (PD201400031)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA