RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04059
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for a right foot condition, rated at 10%.

CI CONTENTION:  The applicant requests 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 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 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 20090225	VA* - (~3 yrs & 9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries Other, Due to Right Foot Pain	5284	10%	No VA Placement	
Bilateral Hallux Valgus	Not Unfitting  	No VA Placement	
Onychomycosis	Not Unfitting	No VA Placement	
Status Post Right Tarsal Tunnel Release	Not Unfitting	Right Ankle Tarsal Tunnel Release	5271	10%	20121221	
		Scar Right Ankle	7805	0%	20121221	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  10%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20131024 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Foot Condition.  The service treatment record (STR) contained few clinical encounter documents regarding the CI’s foot condition.  Medical Evaluation Board (MEB) related documents revealed a remote history of a right ankle injury requiring a surgical tarsal tunnel release in 2002. The CI re-injured the right ankle upon stepping in a hole in late 2006.  X-rays incidentally revealed bilateral pes planus (flat feet) and hallux valgus (bunions).  Podiatric records began in late 2008 whereby the CI was diagnosed according to the radiographic findings and treated with orthotic supports.  Pursuant to persistent painful feet, the CI was permanently profiled and referred to an MEB.  At the MEB examination on 26 January 2009 (2 months prior to separation), the CI reported a “crampy” right foot arch pain without associated numbness or altered sensation.  He endorsed the inability to run, or perform prolonged walking or standing.  His painful symptoms were relieved with ‘rest and elevation.’  His physical examination revealed tenderness to the arch of the right foot without bony involvement.  Bilateral bunions as well as flat feet were identified.  There was no evidence of nerve entrapment or ankle effusion.  All neurovascular parameters were normal about both feet.  His metatarsophalangeal joints were non-tender.  A ‘slight’ antalgic gait was present.  Ankle range-of-motion (ROM) was not recorded.  The VA Compensation and Pension (C&P) examination was nearly 4 years after separation and therefore its findings were not considered for a recommended impairment rating.
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for right foot pain under code 5284 (other; foot injuries), judging that the symptoms were of a “moderate” severity IAW §4.71a.  The VA had no placement specifically assigned to right foot pain.  Board members first agreed that in the presence of “severe” flat feet the verbiage of arch of the foot (as in the NARSUM) was more of an anatomy description of the mid-foot area and not an actual ‘arch’ in the foot.  Additionally, members agreed that in light of a documented foot injury and the presence of mid-foot tenderness without bony involvement coupled with an altered gait would support ‘moderate’ (10%) impairment under the PEB’s unilateral code of 5284.  Absent altered ROM, significant ankle pathology, or bony mal-union, there were no alternative coding pathways to a higher rating.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s 10% rating for the right foot pain condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral hallux valgus, onychomycosis (toenail fungus), and the status post right tarsal tunnel [surgical] release conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Neither the onychomycosis nor the post-surgical release were profiled or implicated in the commander’s statement and were not judged to fail retention standards.  Both conditions were reviewed and considered by the Board.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the toenail fungus or post-surgical release procedure and so no additional disability ratings are recommended.

Bilateral Hallux Valgus.  Although not implicated in the commander’s statement, this condition was listed on the permanent profile and was judged to fail retention standards.  Board members extensively reviewed the STR clinical encounter documents and agreed that the CI’s vast complaints were directed at the mid-portion of his foot without specific notation to bunions.  The initial rendering of the diagnosis was not based upon any clinical presentation, but rather an incidental finding/verification on X-ray analysis.  Members concluded that the specific of presence hallux valgus did not significantly interfere with satisfactory duty performance and therefore agreed with the PEB’s adjudication of not-unfitting.

BOARD FINDINGS:  In the matter of the right foot pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral hallux valgus, onychomycosis, and status post right tarsal tunnel [surgical] release) conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 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 AR20160004453 (PD201404059)

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