RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01058
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Wheeled Vehicle Mechanic, medically separated for chronic bilateral foot pain, with a combined disability rating of 20%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is 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 - 20060227	VARD - 20060823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain due to Degenerative Joint Disease of the First Metatarsophalangeal Joint	5281	10%	Status Post Right First Meta-tarsophalangeal Joint Fusion for Hallux Rigidus, Status Post Right Great Toe Bunionectomy	5281	10%	20060701	
Chronic Left Foot Pain Secondary to Talonavicular Impingement, Status Post Exploration, Debridement, Exostectomy of the Navicular Joint and Bunionectomy	5099- 5003	10%	Status Post Left Talonavicular Joint Debridement and Exostectomy	5271	0%	20060701	
			Status Post Left Great Toe Bunionectomy, Left Hallux Limitus	5281	10%	20060701	
			Bilateral Pes Planus	5276	10%	20060701	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in late 1998 after a 30-mile ruck march.  His treatment was intermittent, prolonged, and included multiple surgeries upon both feet between the period of 2003 and 2005.  Despite surgical intervention and post-surgical restrictive treatments, the CI’s condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic bilateral foot pain with [left] hallux limitus (stiffness of the big toe joint) and [right] hallux rigidus (arthritis of the big toe joint), status post multiple surgeries; and symptomatic pes planus” for PEB adjudication.  

The 24 September 2005 MEB podiatry addendum, 6 months prior to separation, noted complaints of pain in both bunion joints (near the big toe) with walking and running in excess of a quarter mile.  His physical examination (PE) revealed motion-induced crepitus and limited motion of the left big toe joint.  His gait was antalgic and pes planus was also identified.  

At the 6 February 2006 MEB NARSUM examination, 2 months prior to separation, the CI’s chief complaint was chronic bilateral foot pain and pes planus (flat feet).   His PE revealed decreased range of motion (ROM) of the left big toe joint and zero ROM of the right big toe joint.    

At the 19 June 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported bilateral foot pain without flare-ups.  He denied wearing special footwear or the need for an assistive device.  His PE revealed bilateral foot tenderness.  The proximal big toe joint on the right was fused without motion.  The left proximal big toe joint demonstrated normal but painful motion.  Bilateral pes planus was also noted.        

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5281 (hallux rigidus, unilateral, severe), citing inability to fully perform common soldier tasks.  The PEB also rated the left foot condition 10%, analogously coded 5003 (arthritis, degenerative), citing degenerative arthritis with some loss of joint motion.  The VA rated each foot separately at 10% under code 5281 based upon the C&P examination 3 months after separation, citing the conditions’ severity.  

The Board first agreed that code 5281 was appropriate and correctly identified the primary pathology and surgical correction of the right foot.  The sole impairment rating under this coding option is 10% (the VASRD redirects 5281 to code 5280 [hallux valgus; unilateral]).  Therefore, 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’s adjudication for the right foot condition.  

In reference to the left foot condition, all Board members agreed that painful motion was present as to support VASRD 4.59 (painful motion) for a 10% rating.  Additionally, members also considered code 5284 (foot injuries; other), but the left-sided condition would not be supported over “moderate’ (10%) impairment; the same as for painful motion.  Having no significant additive benefit to the PEB’s current 10% under the analogous arthritis code, members agreed that there was insufficient cause to recommend a change in the PEB’s adjudication of 10% for the left foot condition.    

BOARD FINDINGS:  In the matter of the bilateral 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005673, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure