RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00127
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Trainee, medically separated for “right foot injuries,” with a disability rating of 10%.  

CI CONTENTION:  After discharge, the VA awarded a higher rating for his 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 - 20080513	VARD - 20090603	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Injuries…	5284	10%	Healed Right Foot Fracture with Metatarsal Strain	5284	10%	20090211	
Adjustment Disorder without Anxiety and Depressed Mood	Does Not Constitute a Physical Disability	Mood Disorder due to General Medical Condition with Features of Anxiety and Depression	9434	50%	20090204	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Foot Injuries.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in November 2007.  The CI was diagnosed with a right foot cellulitis and underwent surgical debridement.  At a January 2008 orthopedic evaluation, the CI reported persistent right foot pain.  The physical examination showed significant, non-tender scar tissue deep to the incision. There was pain at the incision with movement of the great, second and third toes.  The CI underwent physical therapy without pain relief.  Radiographic evaluation in February 2008 demonstrated a right lateral cuneiform (a foot bone) stress fracture.  The MEB forwarded “right foot cellulitis and abscess with residual foot pain without osteomyelitis” and “right lateral cuneiform stress fracture” for PEB adjudication.  

The MEB NARSUM examination on 09 April 2008, 1 month prior to separation, noted complaints of residual pain at the incision site which prevented running and prolonged walking or standing.  Physical examination showed tenderness to palpation at the plantar 2nd metatarsal and lateral cuneiform areas.  The examiner noted that the CI ambulated in a right controlled ankle movement (CAM) boot.  At the 11 February 2009 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported aching pain in the sole of the right foot, 4 times per week; lasting for 2 hours per episode.  Physical examination showed tenderness to palpation of the right foot arch, a right limping gait, and painful foot motion.  There was not any edema, disturbed circulation, weakness, atrophy of the musculature, heat, redness, and instability.  There was no active motion in the metatarsophalangeal joint of the right great toe.  The ankle range of motion was normal (dorsiflexion to 20 degrees, plantar flexion to 45 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot injuries condition 10%, coded 5284 (moderate foot injury).The VA rated the right foot condition 10% coded 5284, based on the VA C&P examination 9 months after separation, citing subjective complaint of pain in the bottom of your foot and objective evidence of painful motion.  The VA additionally rated the foot scar at 0%.  The Board noted that the CI was able to ambulate in a CAM boot and reported persistent right pain.  There was no evidence of muscle atrophy or weakness.  Board members agreed that the evidence did not support a rating for moderately severe foot injury for a 20% rating.  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 injuries condition.  

Contended PEB Conditions:  Adjustment Disorder without Anxiety and Depressed Mood.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition does not constitute a physical disability.  In accordance with DoDI 1332.38, E4.13.1.4 and E5, adjustment disorder is a condition or circumstance that does not constitute a physical disability, and is therefore not compensable.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right foot injuries condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder without anxiety and depressed mood condition, the Board unanimously recommends no change from the PEB determination as not constituting a physical disability.  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 20150204, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170002967 (PD201500127)

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