RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02571
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated for “chronic pain, left foot” with a disability rating of 10%.  

CI CONTENTION:  The CI asks the Board consider the left foot hallux valgus and bilateral pes planus conditions.  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 based upon a 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 - 20060719	VARD - 20070709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Foot, due to Metatarsal Bursitis and First Metatarsal
Phalangeal Joint, Left Foot	5099-5003	10%	Hallux Valgus, with Degenerative Changes, Left Foot, Status-Post Left Bunionectomy	5003-5280	10%	20060601	
			Residual Scar, Left Foot, Status Post Bunionectomy Surgery	7802	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Chronic Left Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot pain condition began shortly after having bunion surgery in January 2005.  Radiographic and clinical evaluations revealed good alignment of surgical instrumentation as well as bursitis of the surrounding metatarsal joint.  Further non-surgical treatment did not result in pain improvement sufficient to allow unrestricted duty.  
The MEB forwarded “chronic first metatarsal bursitis, left foot, recalcitrant to previous bunion surgery” and “degenerative joint disease (DJD) of the first metatarsophalangeal joint, left foot” for PEB adjudication.  At the MEB NARSUM on 1 June 2006, 4 months prior to separation, the CI reported persistent left foot pain surrounding the joint between the big toe and the mid-foot.  Pain was aggravated by high impact activities and prolonged ambulation.  The physical examination (PE) revealed tenderness about the CI’s subjective area of persistent pain.  The VA Compensation and Pension (C&P) examination was performed on the same day of the NARSUM and the documented PE was normal and absent local tenderness.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, analogously coded 5099-5003 (degenerative arthritis), whereas the VA rated the condition 10% under a dual code of 5003-5280 (degenerative arthritis- hallux valgus (bunion)) citing “slight” pain and post bunion surgery, respectively.  Absent abnormal flat or high arched feet, mal or non-union of foot bones, or a level of moderately severe impairment from a foot injury, all Board members agreed that there was no route to an impairment rating greater than the PEB’s current 10%.  Additionally, all Board members agreed that a more accurate coded description of the CI’s condition was 5279 (metatarsalgia); however, changing the adjudicated VASRD code provides no additional rating benefit to the CI and therefore, 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’s adjudication for the left foot condition.  

BOARD FINDINGS:   In the matter of the left 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 20140117, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013859 (PD201402571)

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