RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01613
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090604

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

CI CONTENTION:  She requested consideration of all conditions in her 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 - 20090224	VARD - 20090924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain…	5284	10%	Right Foot Metatarsalgia	5279	10%	20090829	
Adjustment Disorder with Anxiety and Depressed Mood 	Not Unfitting		Adjustment Disorder with Anxiety and Depressed Mood	9440	Not Service Connect-ed (NSC)	20090829	
Chronic Low Back Pain	Not Unfitting	Low Back Strain		5237	10%	20090829 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in June 2006.  The CI denied any specific injury or trauma.  Radiographic studies (bone scan) showed moderate uptake within the first metatarsophalangeal (MTP) joint and a mild focal uptake in the fifth MTP joint; magnetic resonance imaging and X-rays were normal.  Electro-diagnostic studies in July 2008 (11 months prior to separation) were negative for radiculopathy.  Despite treatment, the CI’s ankle condition could not be adequately rehabilitated to meet the physical requirements of her military specialty and she was referred for an MEB.  

At the MEB NARSUM examination in December 2008 (6 months prior to separation), the CI reported pain exacerbated by prolonged standing, walking uphill, road marching, running, and wearing military footwear.  The examiner documented full ranges of motion (ROM) with tenderness of the midfoot (at the third and fourth MTP) and laterally (along the peroneal nerve distribution).  At a physical therapy examination in December 2008, the examiner documented that “pain cause[d] interference with standing, [and] weight bearing,” and that there were limitations of ROM secondary to pain.  Dorsiflexion was to 5 degrees (normal 20) and plantar flexion was normal, with no changes after repetition.  

At the VA Compensation and Pension (C&P) examination on 28 August 2008 (3 months after separation) the CI reported daily pain over the third and fourth metatarsal heads rated at 7-8/10 with exacerbations with extensive or prolonged walking.  The examiner documented dorsiflexion of 15 degrees and normal plantar flexion with tenderness along the midfoot and laterally.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10% (moderate), coded 5284 (foot injuries, other), citing an inability to perform most required functional activities.  The VA rated the right ankle condition 10%, coded 5279 (metatarsalgia, anterior [Morton’s disease], unilateral, or bilateral), citing anterior metatarsalgia.  The Board noted that on the MEB examination there was tenderness over the third and fourth metatarsal space only without any neurological symptoms, or motor or sensory disturbances.  The Board considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7) however, all Board members agreed that the moderately severe level (20%) was not supported.  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 right foot condition.  

Contended PEB Conditions.  

Adjustment Disorder with Anxiety and Depressed Mood.  The service treatment record documented two episodic visits in July 2007 for an acute reaction to stress, followed by successful counseling classes.  Screening for generalized psychiatric issues were negative at visits in December 2007, January 2008, and at the MEB examinations in June and December 2008.  Chart review performed by psychiatry in January 2009 (5 months prior to separation) described two visits in August and September 2008 for the diagnosis of adjustment disorder, with no other identified psychiatric diagnosis.  The commander’s statement indicated that she was functioning normally.  The MEB designated the condition as meeting retention standards.  The NARSUM documented “ongoing treatment… which [did] not require medication” and that she was “qualified for retention.”  

Chronic Low Back Pain (LBP).  Two visits for back pain in December 2007 and January 2008 documented a normal gait, full ROM, painful motion, and tenderness.  At another visit in June 2008, the CI had had LBP for 8 months, but no pain at the visit, and had requested physical therapy exercises.  The examiner documented a near normal examination with painful motion.  The MEB examination recorded a “normal” spine and designated the LBP as meeting retention standards. The NARSUM documented that she had “no ongoing treatment; no referral indicated…” and that she was “qualified for retention.”  

None of these conditions were profiled nor judged to fail retention standards.  All were reviewed and considered by the Board.  There was no indication from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the adjustment disorder with anxiety and depressed mood and chronic low back pain and, therefore, no additional disability ratings can be recommended.  

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.  In the matter of the contended adjustment disorder with anxiety and depressed mood and chronic low back pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140410 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160007461 (PD201401613)

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
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