RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00138
BRANCH OF SERVICE:  Army	BOARD DATE:  20150731
SEPARATION DATE:  20071115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, (Ml Armor Crewman) 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 but was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “metatarsalgia secondary to a plantar flexed third metatarsal head, right foot” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition for PEB adjudication.  The Informal PEB adjudicated “chronic right foot pain” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to meet retention standards.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Was diagnosed with sleep apnea while in service and did not receive any rating from PEB upon discharge”

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 20070926	VA* - (~2Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5279	10%	Right Foot Metatarsalgia	5279	10%	20080114	
Obstructive Sleep Apnea	
Not Unfitting 
	Mild Obstructive Sleep Apnea	6847	30%	20080114	
Other x 0 (Not In Scope)	Other x 10 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20080501 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Foot Pain Condition.  Treatment records evidence that the CI had a 5-year history of right foot pain despite conservative management.  The narrative summary noted dull, throbbing foot pain which was rated 3-5/10.  The pain worsened with high impact activities.  The physical examination revealed callous formation at the 3rd metatarsal head which was tender to palpation and with motion.  Radiographic evaluation demonstrated a slightly plantar flexed 3rd metatarsal head.  A diagnosis of metatarsalgia secondary to plantar flexed 3rd metatarsal head, right foot was rendered.  At the VA Compensation and Pension examination performed 2 months after separation, the CI reported constant pain in the right metatarsal area which increased with ambulation or running.  The CI did not take any pain medication.  On physical examination there were hammer toes of the 2nd and 3rd digits with callus formation and tenderness to palpation with heavy callus formation at the 1st and 3rd metatarsal heads.  A diagnosis of metatarsalgia was rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the chronic right foot pain condition at 10%; coded 5279 (metatarsalgia, unilateral).  The Board considered whether the evidence supported a higher than 10% rating.  There was no evidence of moderately severe foot injury or metatarsal bone malunion for a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic right foot pain condition was appropriately recommended in this case.

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 chronic right 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 re-characterization 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 XXXXXXXXXXXXXXXXXXXX, AR20160000414 (PD201400138)

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