RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01382
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Calvary Scout, medically separated for “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 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 - 20070321	VARD - 20070925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5279	10%	Residuals, Fracture, 5th Metatarsal, Right	5283	0%	20070818	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot pain condition began in March 2005 after an inversion injury that caused a fracture to the base of the right fifth metatarsal bone.  The CI was initially treated with casting and a period of controlled ankle motion (CAM) walker use, but he continued to have pain and X-rays showed nonunion of the fracture.  He underwent surgery for removal of the symptomatic nonunion in September 2005.  The CI improved after surgery but had persistent foot pain with activity.  

At the 22 February 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported right foot pain with usual pain levels graded 2-3/10.  He was able to walk without a load on his back for 2-3 miles without significant pain.  Wearing hard-soled footwear extended his walking range by approximately 50 percent.  Physical examination noted the examiner’s observation over multiple visits that the CI had a normal gait with lower reported levels of pain, but if pain level increased an antalgic gait was observed.  The surgical scar was well healed and non-adherent.  There was no evidence of nerve injury.  Ankle range of motion was normal and symmetrical.  Peroneal strength (muscles on outer aspect of calf) was graded 4/5 compared to 5/5 on the left side.  All other muscle strength of the lower extremity and foot was normal.  Foot X-rays showed no evidence of arthritis.  

At the 18 August 2007 VA Compensation and Pension (C&P) feet examination, 3 months after separation, the CI reported pain on the bottom of the right foot and heel.  He reported discomfort after weight bearing for 2 hours.  He took over-the-counter anti-inflammatory medication as needed.  He reported he was able to complete his duties at work and could walk a mile slowly.  The physical examination noted that the surgical scar was non-tender and non-adherent.  There was “mild” tenderness along the base of the fifth metatarsal on the bottom of the foot and along the plantar fascia at the heel.  The examiner noted that the CI had an “otherwise, a normal foot examination with normal ranges of motion without pain.”  The VA examiner’s impression was “transfer metatarsalgia” or plantar fasciitis (PF), secondary to the fifth metatarsal fracture and indicated the CI’s “residuals appear to be mild in nature.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for right foot pain under the 5279 code (metatarsalgia).  The VA assigned a 0% rating using the 5283 code (metatarsal malunion or nonunion) citing that the CI had failed to attend a scheduled C&P examination in July 2007, without mention of the August 2007 examination.  There was no later VA Rating Decision in record.  

The PEB assigned a 10% rating as noted above.  Therefore, the panel reviewed to see if a higher rating was supported with any applicable VARSD code.  The panel agreed that the evidence did not support characterizing the disability due to the fifth metatarsal fracture as “moderately severe” for a higher rating coded as 5283 or 5284 (other foot injury).  The VA examiner indicated that the CI’s foot pain may also been related to PF.  However, coded as 5399-5310 (analogous to muscle Group X injury) IAW VASRD §4.73 (muscle injuries), an analogous code for PF, the panel agreed that the disability could not be characterized as “moderately severe” under this code either to support higher than a 10% rating.  There was therefore no higher rating available than 10% rating as adjudicated by the PEB under any applicable VASRD code.  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 adjudication for the right foot pain condition.  

BOARD FINDINGS:  In the matter of the right foot pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were 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

AR20170008444, XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure