RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04209
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic pain 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 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 - 20040209	VARD - 20040630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Foot	5099-5003	10%	Fractured First Metatarsal Head and Sesamoid, Right Foot	5284	10%	20040416	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain Right Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in February 2002 after a heavy item was dropped on it, resulting in a fractured medial sesamoid bone (a small accessory bone underneath the ball of the foot).  Following surgery of the sesamoid in November 2002, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right foot pain (sesamoid bone nonunion)” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 23 June 2003, 11 months prior to separation, the CI reported numbness and tingling in the right foot and right big toe.  Walking long distances or prolonged standing caused pain.  He could not run due to pain and reportedly walked with a limp.  The NARSUM examination on 4 February 2004, 4 months prior to separation, indicated that pain continued to prevent running and performance of military activities.  Physical examination showed tenderness over the sesamoid region and painful motion with extension of the great toes.  There was no other pain or swelling about the foot.  An X-ray showed nonunion of the sesamoid fracture.

At the VA Compensation and Pension (C&P) examination on 16 April 2004, 1 month before separation, the CI reported that prolonged standing and walking aggravated his right foot pain.  Physical examination showed a limping gait which favored the right foot.  He could rise on his toes and stand on one foot, although this caused pain.  Range of motion was present in the right great toe.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB utilized an analogous 5003 code (degenerative arthritis) and cited the US Army Physical Disability Agency Pain Policy as a rationale for a 10% rating.  The VA used the 5284 code (foot injuries, other) in arriving at the same rating.  Board members agreed that a 10% rating was easily supported by the presence of functional loss (§4.40) or painful motion (§4.59), but deliberated a higher rating under the 5284 code.  It was concluded that the ‘moderate’ descriptor under this code most accurately depicted the condition, and therefore the 10% rating was justified.  There was no route to a higher rating under the 5280, 5281 or 5283 codes.  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 pain condition.

BOARD FINDINGS:  In the matter of the chronic 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 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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018285 (PD201404209)

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