RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03880
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20050316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “sensory neuropathy, right foot” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.” 

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 – 20041217	VARD - 20051108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sensory Neuropathy of the Right Foot	5271	0%	Neuropathy, Right Foot	8599-8520	10%	20050830	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Sensory Neuropathy of the Right Foot.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in 2000 after twisting his right ankle during physical training.  Despite acute and conservative treatment for the initial injury, the CI developed a long-lasting sensory abnormality about the lateral aspect of his right foot.  X-rays and electro-diagnostic testing were normal.  There was no surgical indication, and further aggressive physical therapy did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “sensory neuropathy of the right foot” for PEB adjudication.  At the MEB NARSUM dated 07 July 2004 (8 months prior to separation), the CI reported numbness and tingling in his right foot.  The physical examination (PE) revealed a six centimeter area of sensory loss over the outside of the right foot extending towards the heel.  There was decreased ankle range of motion (ROM) as well as slight weakness.  At a VA Compensation and Pension (C&P) examination dated 30 August 2005 (6 months after separation), the PE revealed similar altered sensation in the right foot as previously described in the NARSUM 14 months earlier.  Ankle ROM was decreased without painful motion or weakness.  There was no additional limitation in ROM due to repetition.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Ankle ROM
(Degrees)	MEB ~8 Mo. Pre-Sep
(20040707)	 VA C&P ~6 months Post-Sep 
(20050830)	
Dorsiflexion (20 Normal)	-5	0	
Plantar Flexion (45)	30	40	
Comment	4/5 strength; 
sensory deficit	normal strength; 
sensory deficit	
§4.71a Rating	10%-20%	10%-20%	

The Board directed attention to its rating recommendation based on the above evidence.   The PEB rated the right foot/ankle condition under VASRD §4.71a (musculoskeletal system) at 0% whereas the VA rated the same condition under VASRD §4.120 (neurologic conditions) at 10% citing “mild” incomplete paralysis below the knee.  Board members first considered either rating IAW ROM parameters or under neurology criteria for the loss of sensation.  With regards to rating under a neurologic code, the criteria parameters state that “when the involvement is wholly sensory, the rating should be for [mild], or at the most, a [moderate] degree.”  In this case, the persistence of a sensory deficit coupled with normal ankle strength supports the “wholly sensory” parameter and therefore, would rate no higher than 10% (moderate) under the anatomic appropriate deep peroneal nerve supplying sensation to the lateral aspect of the foot.  With regards to ROM, all Board members agreed that the significant and persistent limitation of ankle dorsiflexion coupled with additional limitation of plantar flexion was synergistically above a [moderate] impairment and was more consistent with [marked] impairment and thus in support of a 20% impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right foot/ankle condition.  

BOARD FINDINGS:  In the matter of the right foot/ankle condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Sensory Neuropathy, Right Foot	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140818, with attachments
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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
 (PD201403880)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA