RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-01161
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080509

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Carpenter and Masonry Specialist, medically separated for “pain in right foot rated as metatarsalgia” with a disability rating of 10%.

CI CONTENTION: “Review all conditions.” The CI’s 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 - 20080205		VARD - 20080617	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Pain in Right Foot Rated as Metatarsalgia	5299-
5279	10%		Post-traumatic Arthritis and Metatarsalgia, 4th Metatarsophalangeal Joint Right Foot	5299-
5279	NSC	20080306	
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Right Foot Pain. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI stepped on a nail with his right foot in December 2005 which developed into a bone infection (osteomyelitis) requiring surgical drainage and long-term intravenous antibiotics  and activity  restrictions. By  September 2007, while preparing for deployment, the CI re-developed pain in his right foot after increasing his physical activities. Diagnostic imaging revealed degenerative changes about the right foot. Despite continued limited activities, medications, and orthotics, the foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he

was referred for MEB. The MEB forwarded “post-traumatic arthritis and metatarsalgia, 4th metatarsophalangeal joint, right foot” for PEB adjudication.

At the 26 December 2007 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint was “painful right foot.” His physical examination (PE) revealed tenderness, painful motion, and decreased sensation about the 4th metatarsophalangeal (midfoot) joint.   At the 6 March 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported constant pain and stiffness about the right foot and was aggravated by walking or physical exertion. He endorsed the ability to perform his activities of daily living, but cannot do his usual work at construction. His VA PE revealed tenderness over the 1st and 4th metatarsophalangeal joints and limited/painful motion of the right great toe. His gait remained normal.

The panel directed attention to its rating recommendation based on the above evidence. Both the PEB and VA analogously code the right foot condition as 5299-5279 (metatarsalgia; anterior) and rated the condition at 10%. The VA did not service-connected the right foot condition. Panel members agreed the historical evidence of a treated metatarsal bone infection resulting in local pain clearly was best supported by the PEB’s chosen primary code of 5279 and therefore, its sole rating level of 10% was appropriate in this case. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the right foot condition.

BOARD FINDINGS: In the matter of the right foot condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. The panel, 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 20150601, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012851, XXXXXXXXXXXXXXXXXX 

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,