RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00410
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for right foot pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “neuritis third intermetatarsal space right foot and plantar medial digital nerve, right hallux” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the right foot pain condition as unfitting, rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 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:  

IPEB - Dated 20040108	VA* - (~1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5279	10%	Residuals Multiple Neuroma Removal/ Right Third Intermetatarsal/Scar	7804	10%	20040325	
			Residuals Multiple Surgery, Right Tibial Sesamoid/Scar	7804	10%	20040325	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 10	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20040603 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Foot.  The CI was first seen for a right foot complaint on 13 February 1998 when she complained of a numb toe (not specified) after a cold injury 2 days earlier.  She was returned to duty and noted to not have frostbite.  An X-ray done 2 weeks later to rule out a stress fracture was normal.  She was seen again a year later with persistent pain.  She was then evaluated in orthopedics on 16 June 1999 and thought to have a Mortons neuroma (a benign growth of a nerve between the first “knuckles” of the 2nd and 3rd toes) and plantar fasciitis.  She was treated with injections and light duty, but her symptoms persisted.  On 8 January 2000, she was treated with crutches and duty restrictions for a fracture of a small bone in the foot (sesamoid) after a heavy truck sideboard was dropped on her foot.  On 19 December 2001, she had surgery to remove the fracture fragment and resection of the Mortons neuroma.  Her pain persisted and on 20 February 2002, the remainder of the sesamoid was removed as well as the stump of the neuroma.  Her pain improved, but did persist.  On 17 June 2003, she dropped a wire spool on her right foot.  X-rays were normal and she was treated with duty restrictions, elevation, and medications.  She was not able to return to full duty and referred for an MEB.  The CI was issued an L3 profile, for chronic right foot pain, allowing an alternate aerobic event and soft shoes as needed on 20 November 2003.  The narrative summary (NARSUM) examination was accomplished on 1 December 2003, 3 months prior to separation.  She reported continued pain at the site of the neuroma excision with relief of pain at the site of the sesamoid excision.  However, she had persistent tingling at the latter site.  She endorsed pain with activity, even with walking over 1/4 mile.  On examination, her sensation was absent at the site of her neuroma excision, an expected outcome.  The range-of-motion (ROM) of the ankle, foot, and toes was normal.  The scars were noted to be present, but no comment made on size or tenderness, implying that they were well healed, but not specifically so stating.  She was thought to have a persistent neuritis.  At the MEB examination on 10 December 2003, the plantar flexion of the right great toe was noted to be reduced and painful with hyper-flexion.  At the VA Compensation and Pension (C&P) examination performed on 25 March 2004, one month after separation, the CI reported persistent pain between her toes at the site of the neuroma excision and that the scars were tender to touch.  On examination, both were sensitive to minimal pressure, but well healed.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right foot pain at 10%, coded 5279 (metatarsalgia, Mortons neuroma), for the history of the neuritis.  The VA rated the two surgical scars at 10% each, coded 7804 (scars).  The Board first considered if the scars were separately unfitting.  While these were noted by the NARSUM examiner, they were not determined to fail retention standards by the examiner or the MEB.  Neither the profile nor commander specifically addressed the scars.  The CI was allowed a soft shoe as needed, but this was in the context of a re-injury several months earlier and ongoing pain at the surgical sites.  The evidence does not support the addition of the scars as separately unfitting conditions.  The Board then considered the right foot pain.  The code 5279 used by the PEB provided the best description for the underlying disability.  The Board also considered the code 5284 (other foot injuries), but this provided no rating advantage to the CI as a moderate injury supports a 10% rating.  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 chronic right foot pain 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.  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 20140114, 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, AR20160003198 (PD201400410)

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