RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00875
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Mechanical Mission System Operator, medically separated for “bilateral foot pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  The CI’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 - 20030501	VARD - 20030528	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5299-5279	10%	Status Post Left Fourth PIP Joint Arthroplasty	5299-5283	10%	20030317	
			Status Post Right Bunionectomy	5280	10%	20030317	
			Bilateral Plantar Fasciitis	5299-5276	0%	20030317	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Bilateral Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began in 2000 after kicking a door.  The CI underwent left fourth toe fusion (to metatarsal including flexor tendon transfer) in March 2001 and right bunionectomy (great toe surgery) in February/March 2002.  He developed bilateral foot pain and was treated with shoe inserts (orthotics) and medications without relief of bilateral foot pain.  Despite treatment, the bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “bilateral foot pain” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated September 2002, 11 months before separation, the CI reported bilateral foot pain with numb spots of his feet following surgery on both feet.  He wore orthotics and was unable to run.  The examination showed a right bunionectomy scar.

At the VA Compensation and Pension (C&P) examination in March 2003, performed 5 months before separation, the CI reported bilateral foot pain following a right bunionectomy and a left fourth toe fusion leading to a deformity.  He complained of pain with weight bearing increased with activity or wearing boots.  The CI used customized orthotics.  The examination showed well healed surgical scars on the feet.  Gait was abnormal and there was tenderness to the right great toe area and the bilateral plantar fascia insertion sites.  The left fourth toe was in a hammertoe cockup position and there was no active motion (flexion contracture).  There was no neurovascular deficit of the feet.  The examiner advised follow-up with specialists for assistance in obtaining a normal gait.

At the MEB NARSUM examination dated April 2002, 4 months before separation, the CI reported bilateral foot pain and a history as noted above.  The examination showed an abnormal gait.  There was tenderness at the right first metatarsophalangeal joint, medial first metatarsal shaft, as well as the peroneal tendons bilaterally.  The right first metatarsophalangeal joint (great toe) motion was limited and his right great toe and left fourth toe did not touch the ground while standing.  Surgical scars were well healed and neurovascular status was intact.  X-ray demonstrated retained screws on the right and an elevated right first toe and left fourth toe.  The examiner indicated severe hammertoe and numerous foot and ankle complaints not alleviated by treatment.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5279 (metatarsalgia, anterior (Morton’s disease)).  The VA assigned a 10% rating for the left foot using an analogous code 5283 (tarsal, or metatarsal bones, malunion/nonunion); a 10% rating for the right foot using code 5280 (hallux valgus, unilateral); and a 0% rating for the bilateral feet using an analogous code 5276 (flatfoot, acquired); all based on the VA C&P examination 5 months before separation, citing an abnormal gait, right bunionectomy with pain, left toe surgical fusion (hammertoe cockup) with no active motion, and tenderness to the plantar fascia bilaterally.  The VA C&P exam and MEB exam were very similar with regards to ratable features of the feet, although the rating schemas were substantially different.  The Board adjudged that each foot was reasonably separately unfitting.  Although code 5279 allows for a bilateral 10% rating, the CI’s left foot pathology did not clearly align with that coding (a type of neurologic pain), and it also did not account for the overlapping contribution of the plantar fasciitis/peroneal tendinopathy noted on exams.  The Board carefully noted the provisions of VASRD §4.14 (avoidance of pyramiding).

The Board determined that the CI’s disability picture at separation warranted a 10% right foot rating analogous to 5276-5280 and that the combined left foot disability picture more nearly approached the 10% disability picture under 5276-5283.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends that each foot be separately unfitting with a disability rating of 10% for the right foot coded 5276-5280; and 10% for the left foot coded 5276-5283.

BOARD FINDINGS:  In the matter of the bilateral foot pain condition, the Board unanimously recommends that each foot be separately adjudicated as follows:  an unfitting right foot condition rated 10%, coded 5276-5280 and an unfitting left foot condition rated 10%, coded 5276-5283; both IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Foot Pain	5276-5280	10%	
Left Foot Pain	5276-5283	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140218, 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, AR20160007262 (PD201400875)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA