RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01078
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Health Care Specialist, medically separated for “left foot pain” with a disability rating of 10%.

CI CONTENTION:  The CI contends that after using crutches and walking boots for treatment of his left foot, his back went out of alignment.  The CI stated he also has hypertension and high cholesterol.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20031023	VARD - 20031205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain	5279	10%	Residuals of Left Foot Fracture	5271	10%	20031001	
			Left Foot Nerve Entrapment	8620	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Foot Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot condition began in September 2002 while playing basketball.  X-rays revealed a fracture of the 5th metatarsal bone in his left foot.  Despite a follow-up X-ray dated 27 December 2002 indicating a “healed fracture”, the CI underwent surgical fixation of the bone on 13 January 2003.  Initially, his painful symptoms were relieved, but only to return later in the year.  Considering a pre-surgical diagnosis of possible non-union, Orthopedics decided to remove the previously placed internal hardware and perform a local bone graft on 7 August 2003.  During surgery, it was discovered that the CI’s resumption of pain was due to erosion of previously placed hardware and not due to bony non-union.  The MEB forwarded “healing fracture and reconstructive ligamentous procedure metatarsal 4 and 5, left foot” for PEB adjudication. 

The 27 September 2003 MEB NARSUM examination, 4 months prior to separation, noted the CI’s chief complaint as foot pain.  His physical examination (PE) revealed swelling of the entire left foot as well as decreased sensation on the outside and forward portion of the left foot.  Ankle range of motion (ROM) was painful and decreased measuring 5 degrees of dorsiflexion (normal 20) and 20 degrees of plantar flexion (normal 45).  His gait was antalgic.   

At the 5 December 2003 VA Compensation and Pension evaluation, performed 2 months prior to separation, the CI reported daily left foot pain.  His detailed PE revealed left ankle swelling and darkened in color.  There was painful and decreased ankle ROM measuring 10 degrees of dorsiflexion and 20 degrees of plantar flexion.  His gait was inconsistently documented, but the CI was wearing a support boot.     

At an Orthopedic examination on 19 April 2004, 2 months after separation, the CI’s PE revealed tenderness about the left ankle and improved plantar flexion to 30 degrees as compared to prior measurements.  Left ankle dorsiflexion remained decreased at 10 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition at 10%, coded 5279 (metatarsalgia, unilateral) whereas, the VA rated the left foot condition at 10% coded 5271 (limited motion of the ankle) and 10% coded 8620 (sciatic nerve neuritis), based on the VA C&P examination 2 months prior to separation, citing decreased and painful motion and mild paresthesias in the surgical area.   Panel members considered VASRD coding options between 5271 (ankle, limited motion), 5279 (metatarsalgia), and 5284 (foot injuries; other) to determine a final impairment rating.  Although ROM of the left ankle was documented in each examination as being decreased and or painful, all panel members agreed that the primary condition and surgical intervention of the metatarsal bone was anatomically distant to the ankle and therefore, not best represented under 5271.  Secondary to the site of injury and surgical fixation, VASRD code 5279 appeared most logical and anatomically appropriate with its sole rating of 10%.   Panel members then considered if a higher rating under 5284 was above a “moderate” (10%) impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed that the evidence of “swelling of the entire left foot” at the NARSUM examination as well as the need to wear a foot-boot support after separation indicated impairment above “moderate” and below “severe” and thus recommends a disability rating of 20% (moderately severe) for the left foot pain condition, coded 5284.  

BOARD FINDINGS:  In the matter of the left foot condition, the panel unanimously recommends a disability rating of 20%, coded 5284 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Foot Pain	5284	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007439, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure