RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00987
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E1, Combat Medic, medically separated for “chronic right foot pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 confined to 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 - 20081112	VARD - 20091022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain and Numbness due to Residual of Resolved Cellulitis and Heel Abscess	5299-5284	10%	Right Foot Condition due to Residual of Resolved Cellulitis and Heel Abscess with Surgical Post Scar	8599-8520	0%	20090110	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right foot pain condition began in May 2008 while enrolled in basic training.  The CI developed a right heel blister developed an ulcer and became infected (cellulitis).  Surgery (incision and drainage) was performed in May 2008.  Following surgery, further treatment did not result in improvement sufficient to allow return to training or unrestricted duty.  

At the MEB examination (recorded on DD Forms 2807 and 2808) and NARSUM in October 2008, 2 months prior to separation, the CI reported chronic right foot pain with flares on prolonged standing and an inability to run.  She also had no feeling on the inside of her right foot where she had surgery.  She denied ankle pain.  The MEB physical examination noted a normal gait and stance with no difficulty or discomfort getting on or off the examination table.  The 2 inch right heel vertical scar was well healed and non-tender.  There was no foot tenderness, edema or skin discoloration.  Motor strength, reflexes and vascular tests were normal.  There was full and painless ankle range of motion.  There was a variable decrease in pinprick sensation over the medial aspect of the dorsum and plantar surface of the right foot which was not in a dermatomal distribution.  

At the VA Compensation and Pension (C&P) examination in February 2009, performed 4 months after separation, the CI reported similar condition onset and surgery.  She reported loss of sensation from mid-heel to big toe on the inside of her right foot and that because of the numbness, she was unable to have good balance and unable to run.  The CI indicated she had slight improvement (since discharge).  She had right foot pain if she stood over 2 hours or walked longer than 1-1/2 miles, continued with loss of sensation on the inside of the right foot, from mid-heel to big toe, but indicated that this was slowly getting better and she had learned to balance better, although she still could not run.  

Physical examination showed normal posture, gait, heel and toe walking, and coordination.  There was a 2 x 0.2 cm non-tender keloid scar on the right foot.  The right foot had no edema, tenderness, pain on manipulation, or loss of strength.  There was a zone of diminished sensation in a rectangle extending 1 cm around the scar in the medial aspect of the mid-heel towards the first toe.  The toe itself had normal movement and normal sensory testing.  X-rays were negative.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5284 code (foot injuries, other), citing rating as a moderate foot injury.  The VA assigned a 0% rating using an analogous 8520 code (sciatic nerve paralysis) based on the VA C&P examination 4 months after separation.  The VARD (VA rating decision) narrative cited a zone of diminished sensation and indicated award of a 10% for mild incomplete paralysis below the knee; however, the VARD first page “Decision” and the rating decision summary page both indicated a 0% rating.  The Board agreed that the disability of the right foot was no greater than moderate at the time of separation and that the 5284 coding encompassed the disability from both pain and non-dermatomal sensory loss in the area of the surgery.  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 condition.  

BOARD FINDINGS:  In the matter of the 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160014391 (PD201500987)

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