RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03041
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20080917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aviation Ordnanceman) medically separated for “osteoarthritis localized to the left fourth and fifth tarsometatarsal joints” and “hyperesthesia, consistent with reflex sympathetic dystrophy over the lateral incision site,” rated 10% and 10%, respectively. 

CI CONTENTION:  The applicant has asked for consideration of all conditions in his application.  His 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 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 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 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 20080602	VA* - (~19 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Localized to the Left Fourth and Fifth Tarsometatarsal Joints	5299-5003	10%	Left Foot Arthritis	5284-5010	NSC	20100414	
			Left Foot 5th Toe Bursitis	5283-5019	NSC	20100414	
Hyperesthesia…	8799-8722	10%	Reflex Sympathetic Dystrophy of the Left Foot Status Post Fracture of the Left Fifth Metatarsal	5284	20%	20100414	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20110111 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Osteoarthritis Localized to the Left Fourth and Fifth Tarsometatarsal Joints Condition and Hyperesthesia Consistent with Reflex Sympathetic Dystrophy over his Lateral Incision Site.  Review of the records shows that the CI was first seen for left foot pain on 25 April 2006 when he complained of pain at the base of the left 5th toe.  Fractures were noted bilaterally at the same location on X-ray.  He was thought to have a symptomatic non-union of the left 5th metatarsal base (the long bone below the little toe) and this was excised on 1 September 2006.  Despite the surgery and rehabilitation, he had continued pain.  He was again taken to surgery in March 2007 and had a repair of the peroneus brevis tendon (a tendon which attaches to the 5th metatarsal bone).  He continued to have pain which precluded duty including the wear of his boots.  In follow-up in the foot and ankle clinic on 26 March 2008, he was noted to have abnormal sensation near the incision sites which had improved with time, normal strength, and a normal skin examination.  Motion did not increase his pain.  This was unchanged when re-examined 2 weeks later.  The narrative summary (NARSUM) was dated 7 April 2008 and noted the CI had a new diagnosis of reflex sympathetic dystrophy (RSD), an abnormal neurological response after an injury.  On examination, he had some arthritic changes on X-rays at the 4th and 5th tarsometatarsal joints (tarso – MTJs), where long bones of the feet (4th and 5th) join the ankle.  An injection reproduced his pain.  He was hypersensitive to touch (hyperesthesia) near his incision and both light and deep touch was painful.  The wear of boots was painful.  Sensation was otherwise normal as was motor function.  No skin changes of RSD were documented and the skin was noted to be without excessive redness (hyperemia) associated with inflammation or increased blood flow.  The surgical scar was well healed.  At the VA Compensation and Pension (C&P) examination performed on 14 April 2010, 19 months after separation, the CI reported continued discomfort which was exacerbated by walking over 1/4-mile.  He did not use any assistive device.  He worked in a fast food restaurant and his pain was aggravated by the long standing.  On examination, he had extreme sensitivity to touch, but his gait was normal when observed walking down the hallway.  The neurological examination was intact other than the “extreme sensitivity” (to touch).  X-rays were normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated 10%, coded 5299-5003 (analogous to degenerative arthritis) for osteoarthritis (OA) localized left 4th and 5th tarsometatarsal joints and also for hyperesthesia consistent with RSD at 10%, coded 8799-8722 (analogous to moderate neuralgia of the musculo-cutaneous nerve).  The VA rated 20%, coded 5284 (other foot injuries) for moderately severe RSD and noted that there was no evidence for arthritis on the examination.  This was based on an examination remote from separation.  The Board considered the evidence.  The CI was noted to have sensitive touch near the incision site, but none of the other findings associated with RSD such as skin changes, hyperemia, loss of hair, muscle atrophy, etc.  The arthritic changes were only seen at separation and were not documented on previous X-rays or one after separation.  The Board found no route to a rating higher than the 10% rating adjudicated for each condition by the PEB.  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 OA and RSD conditions.  

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 osteoarthritis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the hyperesthesia consistent with RSD condition and IAW VASRD §4.124a, 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 20140625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 5 May 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN
		- XXXXXXXXXXX, former USN