RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00561
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20070302

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Utilities Systems, medically separated for “chronic right foot pain due to sesamoiditis,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for right and left Sesamoiditis.  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 Physical Evaluation Board (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 - 20070108	VARD - 20070712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5299-5279	10%	Right Foot Sesamoiditis	5284-5276	10%	2007319	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:    

Right Foot Condition.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an atraumatic onset of right foot pain in early 2004.  This was subsequently diagnosed as a lateral sesamoid (a small accessory bone at the base of the big toe) fracture with resulting sesamoiditis.  The CI was followed by podiatry and treated with orthotics and injections, but persistent pain resulted in an MEB (surgery was discussed but reasonably declined).  There were multiple STR entries noting localized tenderness over the ball of the foot consistent with the diagnosis, but no other ratable findings.  There were STR entries confirming a normal gait and full range-of-motion (ROM) at the ankle, with none to the contrary.

The NARSUM was conducted 9 November 2006 (4 months pre-separation) and documented “chronic right foot pain causing inability to run, climb or stand for prolonged periods of time.”  The NARSUM physical examination recorded “significant” tenderness over the lateral sesamoid, with no comment regarding gait or ROM.

A VA Compensation and Pension (C&P) examination was conducted 19 March 2007 (17 days after separation) and documented constant pain rated 10/10, listing functional impairment as “inability to run or even walk for an extended period” and denying the need for orthotics.  The VA physical examination recorded a “notably antalgic” gait, “painful motion and tenderness,” and specifically denied the presence of all VASRD ratable foot deformities (including pes planus).  The VA measured ankle ROM was dorsiflexion to 15 degrees (normal 20) and plantar flexion to 45 degrees (normal).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated analogously to code 5279 (metatarsalgia), conferring the maximum 10% rating allowed.  Members agreed that this analogous choice reasonably reflected the clinical features and disability associated with this case.  The VA rated under code 5284-5276 (foot injuries, other [rated as] pes planus); and, although pes planus was excluded by the VA examiner, the 10% criterion of “weight-bearing line over or medial to great toe” was supported by the VA examination.  There were no other codes under VASRD §4.71a which are applicable and favorable in this case, other than consideration of a 20% under 5284 for “moderately severe” disability; and, members agreed that the functional limitations in evidence were not reasonably characterized as more than moderate.  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 of the right foot condition.

BOARD FINDINGS:  In the matter of the right foot 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.  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 20140109, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00561.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings