RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00864
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Intelligence Analyst, medically separated for “bilateral foot pain due to metatarsalgia”  with a disability rating of 10%.

CI CONTENTION:  “I am unable to stand for long periods of time or walk, I can’t run without pain.”  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 PEB - 20070626	VARD - 20080623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain…	5279	10%	Bilateral Foot Pain due to Metatarsalgia	5020-5276	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Foot Pain Due to Metatarsalgia.  According to the service treatment record (STR) the CI developed a stress fracture of both feet in 2005.  Subsequent to healing however she continued to experience ongoing left foot pain.  The STR reflected multiple visits in 2006 for left foot pain, but by the time of the Medical Evaluation Board (MEB) narrative summary (NARSUM) in April 2007 complaints of bilateral foot pain were reported.  The MEB forwarded “bilateral foot pain secondary metatarsalgia, pain slight and constant” for PEB adjudication.

The 6 April 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral foot pain present about 90% of the time during the day.  It was usually controlled with Motrin.  She could not run, jump or march due to foot pain.  Physical examination showed normal ambulation.  Feet were symmetrical without swelling.  Tenderness of the second dorsal web space was present, and some paresthesia (“pins and needles” sensation with pressure) was present in the second and third web spaces.

On 2 May 2007, 3 months prior to separation, the CI was evaluated by a pulmonologist for a breathing complaint.  During the evaluation, she exercised on a treadmill “to fatigue” and again for 6 minutes “to max. rate of 6 mi/hr.”  At a 13 June 2007 podiatry follow-up evaluation, 2 months prior to separation, the CI complained of 8/10 pain in both feet, and reported that the pain in her left foot was present since basic training.  Orthotic inserts worsened her symptoms so she no longer wore them.  Examination showed tenderness of the feet, but there was no tenderness of the web interspaces suggestive of Morton’s neuroma.  She walked without a limp.  Range of motion of the ankle joints was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain condition at 10%, coded 5279 (metatarsalgia, anterior).  The VA rated the condition 0% using a combination 5020-5276 code (synovitis; flatfoot, acquired), based on the STR, citing mild symptoms relieved by built-up shoe or arch support.  The Board agreed that the 5279 coding approach in this case was the most clinically applicable, and that the maximum rating of 10% via this pathway for the bilateral foot pain was appropriate.  Even conceding the presence of pes planus, Board members concluded that the “severe” bilateral flatfoot and “objective evidence of marked deformity…indication of swelling on use, and characteristic callosities" stipulations required for the next higher 30% rating under the 5276 code were not described by the evidence.  Other foot coding options were inapplicable or were not beneficial 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 bilateral foot pain condition.

BOARD FINDINGS:  In the matter of the bilateral foot pain due to metatarsalgia 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 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005114, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,