RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Special Electronic Devices Repairer, medically separated for “neuritis left superficial peroneal nerve, left foot,” with a disability rating of 10%.

CI CONTENTION: The applicant contends he was not allowed to appeal his PEB decision.  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 on 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 - 20090521	VARD - 20091030	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuritis Left Superficial Peroneal Nerve, Left Foot	8622	10%	Residuals of Left Foot Tendon Transplant with Paresthesia and Weakness	8622	20%	20090707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Neuritis Left Superficial Peroneal Nerve, Left Foot.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot condition began in November 2007, after the CI tripped and fell.  He was diagnosed with an avulsion fracture and was immobilized for a few months with improvement.  He re-injured the foot while doing physical training and was evaluated by podiatry.  Magnetic resonance imaging showed a fibrocartilaginous (fibrous connective tissue and cartilage) calcaneonavicular (tarsal bones) coalition (congenital abnormality) and it was thought to be related to the CI’s persistent foot pain.  He underwent surgery for separation of the fused bones on 29 July 2008.  Following surgery he reported pain worse than before surgery aggravated by side to side movements of the foot, with numbness and tingling into the third, fourth, and fifth toes.  Left foot weight bearing X-rays on 1 December 2008, showed pes planus (flatfoot), post-surgical changes, mild swelling of the soft tissues, and degenerative changes of the first metatarsophalangeal (great toe) joint.  Electrodiagnostic studies 29 December 2008 showed evidence of a focal left superficial peroneal neuropathy (SPN), likely localized to the surgical site.  The CI was diagnosed with neuritis of the left SPN.  The podiatrist explained that nerve injury may take up to 12 months to resolve or may be permanent.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “left calcaneonavicular coalition, post bar resection” as not meeting retention standards and “left partial palsy to the superficial peroneal sensory nerve” as meeting retention standards for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 3 March 2009, 5 months prior to separation, the CI reported pain of the left foot with nerve damage from surgery, requiring use of orthotics.  Physical exam showed a well-healed scar over the top and outer aspect of the ankle.  There was no swelling or discoloration.  The CI was able to heel and toe walk and squat with pain.  There was a positive Tinel’s sign (pain radiating in the distribution of the nerve with percussion over the nerve) over the incision site with numbness of the lateral toes.  There was normal temperature to palpation of the foot.  Strength was normal except for strength graded 5-/5 with ankle inversion and there was pain with resisted inversion.  Sensation was decreased in the distribution of the SPN.  Moderate symptomatic pes planus was noted.  At the MEB NARSUM examination 0n 14 April 2009, 3 months before separation, the CI reported left foot pain with numbness and tingling as noted before.  He reported he was unable to return to wearing combat boots.  The MEB physical exam cited the findings noted at the MEB DD Form 2808 exam above.  Additionally, ankle ROM was reported as dorsiflexion (DF) of 12 degrees (normal 20 degrees) and plantar flexion (PF) normal (normal 45 degrees).  Vascular exam of the lower extremity was normal.

At the VA Compensation and Pension (C&P) examination in July 2009, performed 20 days before separation, the CI reported that he was unable to run or stand for more than 10 minutes without his left foot “falling asleep.”  He reported his left foot, ankle and knee frequently give out and he falls down.  The exam noted the CI had not been given orthotics or special shoes.  Physical exam showed a normal gait and station.  There was no evidence of abnormal weight bearing on his feet or the soles of his shoes.  Manipulation of the foot was not painful.  There was normal alignment of the Achilles tendon and the arch was described as “fairly well preserved.”    There was a scar over the lateral aspect of the foot that was discolored and tender and pressure on the scar caused numbness of the toes and a smaller scar on the bottom of the foot.  There was decreased sensation of the left toes and decreased strength, graded 4/5 of ankle and great toe DF.  Reflexes were normal.  Ankle ROM was DF 20 degrees and PF 45 degrees with pain.  There was no additional loss of ROM with repetition.  The surgical scars did not cause additional limitation of ROM of the foot or ankle.  The examiner indicated that the CI’s limitations in his daily activities were due to the “paresthesias and numbness due to pressure on the scars” and noted that the CI did “not use braces, splints, or assistive devices.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 8622 code (neuritis of the musculocutaneous nerve), citing SPN injury equivalent to moderate incomplete paralysis.  The VA assigned a 20% rating using the 8622 code based on the VA C&P examination 20 days before separation, citing severe incomplete paralysis of foot movements.  There was evidence of persistent pain, numbness and tingling, aggravated by weight bearing activities and footwear, and focal decreased sensation in the SPN distribution consistent with the findings on the EMG/NCV to support a 10% rating coded as 8622 (neuritis of the SPN), which provides a 0% rating for “mild” and 10% for “moderate” incomplete paralysis IAW VASRD §4.124a (neurological conditions).  The Board judged that the evidence at the pre-separation C&P exam of a normal gait without orthotics, braces, splints, or assistive devices did not support characterizing the neuritis as “severe” incomplete paralysis for a higher rating.  The Board reviewed to see if alternatively rating the foot disability with a foot code IAW VASRD §4.71a (musculoskeletal injuries) resulted in a higher rating; however, the rating criteria under 5284 (other foot injury) are also subjective and by similar reasoning as noted for the neuritis, the Board judged that the foot injury was best characterized as “moderate” for 10% rating.  There was no evidence of “severe” pes planus, malunion or nonunion of a tarsal or metatarsal bone for higher rating.  There was therefore no higher rating available with any applicable VASRD code.  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 left foot condition.  

BOARD FINDINGS:  In the matter of the left foot 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 20140519, 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), 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160011130 (PD201403195)

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:
Enciosure
CF:
( ) DoD PDBR
() DVA