RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03086
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150520
SEPARATION DATE:  20030807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Utility Equipment Repairer) medically separated for left foot pain.  The left foot condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left midfoot pain status post left midfoot twisting injury” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the left foot condition as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI appealed to the Formal PEB which affirmed the IPEB findings and rating; she was then medically separated.

CI CONTENTION:  “Please consider all conditions”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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 Military/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 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:

FPEB – Dated 20030610	VA* - (~1 Month Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain…	5099-5003	10%	Old Lisfranc Fracture, Left Foot… 	5283-5024	10%	20030715	
Other x 0 (Not In Scope)	Other x 15	
RATING:  10%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20030805 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Foot Condition.  The CI developed left foot pain in April 2001 during initial training.  An X-ray on 4 May 2001 was normal.  A bone scan on 18 June 2001 was consistent with stress fractures of the left mid-foot.  She continued light duty and medications without resolution.  An magnetic resonance imaging on 6 May 2002 was suggestive of an avulsion fracture (a bit of bone pulled off by a ligament in a sprain).  A follow up CT scan on 6 June 2002 was normal.  Despite duty limitations and a trial of non-weight bearing, her pain continued.  She was issued an L3 profile and referred for an MEB.  The narrative summary was 10 months prior to separation.  It noted that multiple tests had not resulted in a specific diagnosis.  On examination, the CI had painful, but full range-of-motion (ROM) with tenderness over the mid-foot.  She was diagnosed with left mid-foot pain following a twisting injury.  A podiatry note on 19 December 2002 noted that there was increased space between the bones of the mid-foot on stress views when compared to the right.  An injection increased her discomfort.  In orthopedics on 6 January 2003, she was noted to have normal stress X-rays (looking for laxity in the mid-foot ligaments).  However, she was thought to have a chronic Lis Franc injury (a fracture and dislocation of some of the bones of the mid-foot).  At a follow-up podiatry appointment on 14 January 2003, the CI noted that she had no benefit from the injection.  Four months prior to separation, the orthopedic addendum noted mild tenderness over the left mid-foot.  There was no swelling or deformity and stress testing was not painful.  She could do toe raises with mild mid-foot pain.  She was thought to have left foot pain secondary to mild mid-foot degenerative joint disease.  At the VA Compensation and Pension examination performed a month prior to separation, the CI reported continued pain with walking and standing.  On examination, there was no tenderness, swelling, or inflammation.  She was able to rise on her heels and toes as well as heel and toe walk without “evidence of significant discomfort.”  The ROM was normal and equal bilaterally.  Painful motion was not documented.  X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition at 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the pain policy.  The VA also rated the foot at 10%, coded 5283 (malunion of the tarsal or metatarsal bones) and 5024 (tenosynovitis).  The Board considered these codes and the other coding options available and found no route to a rating higher than the 10% adjudicated by both the PEB and VA.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that a disability rating of 10% for the left foot condition was appropriately recommended in this case.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left foot pain condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left foot pain 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.

RECOMMENDATION:  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 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 XXXXXXXXXXXXXXXXXXXX, AR20160003175  (PD201403086)

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