RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03709
BRANCH OF SERVICE:  NAVY			SEPARATION DATE:  20061223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aviation Electronics Technician, medically for “foot sprain of the tar-so-metatarsal joints, right foot,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all 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 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 PED - 20060920	VARD - 20080131  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Sprain of the Tarso-metatarsal Joints, Right Foot	5003-5279	10%	Status Post Foot Sprain Involving the Tarsometatarsal Joints of the Right Foot	5299-5279	10%	20070911	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Foot Sprain of the Tarsometatarsal Joints, Right Foot.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was initially treated for left foot pain during the first month of basic training in October 2005.  On 13 January 2006, she reported a 2-day history of right foot pain while walking.  Trauma was not recorded, but the pain began after running.  Swelling of both feet was noted and she was tender to palpation.  She was issued a shoe of comfort and advised to follow up in 4 days.  The tenderness persisted, but the range of motion (ROM) was full.  An X-ray was normal.  She was evaluated in podiatry on 25 January 2006 and thought to have a possible stress fracture or an injury to the ligaments between the midfoot and forefoot (Lisfranc injury).  A bone scan was suggestive of a stress fracture.  The CI continued duty restrictions and surgery was considered.

In orthopedics on 28 April 2006, the CI reported that pain in both feet had developed in basic training, but that of the left foot had resolved.  It was noted that she had been on crutches for several weeks and had not run for several months, but that her pain persisted.  She was tender to palpation, but not unstable as would be seen in a Lisfranc injury.  It was recommended that the foot be immobilized and in non-weight bearing for 4 weeks.  A CT [computed tomography] scan of the foot on 11 May 2006 was normal.  Her pain persisted and a second 4-week period of non-weight bearing was directed.  It was determined that she had reached maximum medical benefit and could not meet duty requirements.  She was then referred for a MEB with the diagnosis of foot sprain of the tarsometatarsal joints, right foot (joints between the forefoot and the long bones of the feet).  The MEB NARSUM dated 12 July 2006 (6 months before separation) record the aforementioned STR evidence.  The CI’s gait was noted as abnormal secondary to pain.  Magnetic resonance imaging (MRI) on 25 July 2006, was normal and specifically noted a normal Lisfranc ligament.  In orthopedics on 1 August 2006, 5 months prior to separation, she was tender and the ROM painful, but full.  Instability was not recorded.  The CI continued light duty until separation, but further evaluation was not accomplished.

At the VA Compensation and Pension (C&P) examination performed on 11 September 2007, 9 months after separation, the CI reported pain in both hips, the left knee, and right foot.  She had a slightly abnormal gait which was attributed to all four joints.  Motion was painful but not limited.  Tenderness of the foot was present, but here was no edema, instability, or weakness.  An X-ray, accomplished 1 May 2007, had been read as normal by the radiologist, but the VA podiatrist (on 9 July 2007) noted a large separation of two of the bones of the forefoot and recommended surgery.  Surgery was performed on 1 October 2007 with subsequent hardware removal in February 2009.  These clinical records are not in evidence.  The Board found no records to account for the variance in interpretations nor did it find evidence of trauma to account for the podiatry findings as compared to the pre-separation orthopedic examination, CT scan, and MRI.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition at 10%, analogously coded 5003-5279 (degenerative arthritis-metatarsalgia).  The VA also rated the right foot condition at 10%, analogously coded 5299-5279.  A 10% rating is the highest rating under code 5279.  The Board found no other VASRD code to support a rating higher than 10%.  The Board agreed that code 5279 was the most appropriate code for this condition, but it provides no rating advantage to the CI.  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.

BOARD FINDINGS:  In the matter of the foot sprain of the tarso-metatarsal joints, right 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 20140623, 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 8 Aug 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:

- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)