RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01563
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090312

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “chronic right foot pain” and “right lateral thigh pain,” rated 10% and 0%, respectively, with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider 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 - 20081201	VARD - 20090323	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5299 -5279	10%	Right Foot Fibroma to Tendon Sheath	7805	0%	20080211	
Right Lateral Thigh Pain	8799 -8729	0%	No VA Placement		
Iron Deficiency Anemia	Not Unfitting	Normocytic Anemia	7799-7700	NSC		
Hypertension	Not Unfitting	Hypertension	7101	0%		
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 right foot condition began in March 2007 without specific trauma.  X-rays showed a localized small calcific density in the first metatarsal bone.  Magnetic resonance imaging (MRI) of the right foot showed a solid soft tissue mass in the region of the abnormality.  In July 2007 the CI underwent surgery for excision of a soft tissue mass, diagnosed as a fibroma, in the tendon sheath.  

The 22 October 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of tingling and pain in the right foot as well as numbness of the right great toe.  CI noted pain 5/10 when wearing her boots.  The pain increased to 8/10 with swelling when the boots came off.  She tried to wear her Army boots but the laces compressed the site of the fibroma causing significant pain.  CI had no pain when wearing sneakers and was profiled to continue wearing sneakers in uniform.  She walked 30 minutes/day for exercise but her foot would swell with longer distances.  Running significantly worsened her pain.  She was unable to wear her boots, run, ruck, march, carry a fighting load and construct a fighting position.  She could not complete the fitness test nor perform the duties of her MOS.  She was treated with physical therapy and home exercise program with limited improvement.  Physical examination showed she walked slightly favoring her right lower extremity.  The foot showed a 3 cm linear surgical scar along the first metarsal bone which was tender along the scar.  Mild swelling medial to the scar measuring 2x5cm was noted.  There was pain with dorsiflexion of the foot but no pain with plantar flexion.  There was normal strength and reflexes.  The left foot exam was normal.  

At the 11 February 2008 VA Compensation and Pension (C&P) evaluation, performed 13 months before separation, the CI reported pain, swelling and numbness daily in the right foot, precipitated by prolonged standing, walking and wearing boots.  Physical exam showed feet were normal in appearance and no tenderness.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot pain 10%, coded 5299-5279 (analogous to anterior metatarsalgia, anterior (Morton’s disease)), citing normal foot examinations, deep tendon reflexes and sensations, with no atrophy or spasm.  The VA rated the right foot fibroma to tendon sheath 0% coded 7805 (Scars, other (including linear scars)), based on the C&P examination 13 months before separation, citing “a non-compensable evaluation is assigned for scars which are not considered disabling because of limitation of function of the affected part.”

The panel noted there was no evidence of claw foot (5278); weak foot, bilateral (5277); flatfoot, acquired (5276) or foot injuries (5284) that would be eligible for a higher rating.  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.  

Right Lateral Thigh Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right thigh condition began in July 2007 after surgery for the right foot condition discussed above.  The nerve block done for the surgery was in the same area of the thigh pain.  In December 2007, the electro myelogram study (EMG) of the lower extremities and lumbosacral spine was normal but, the pain continued.  Physical therapy did not help the pain.  

At the 11 February 2008 VA Compensation and Pension (C&P) evaluation, performed 13 months before separation, the CI reported no complaints related to the lateral right thigh.  Physical exam showed no pathology of any joint, with normal muscle strength and no pain, weakness, fatigue, or swelling.  

The 22 October 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of shooting pain of 6-7/10 intensity down the right leg with prolonged standing and associated with weakness of the right lowered extremity.  This occurred 3 times per day lasting a few seconds to a few minutes and improved with sitting.  The CI continued to have the pain if she stood longer than 10-15 minutes.  Physical examination showed tenderness and hyper paresthesia of the lateral right thigh in a 14 x 10 cm. region.  Gait and stance were normal overall with slight favoring of the right lower extremity.  Reflexes were normal.  … 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right thigh condition 0%, coded 8729 (Neuralgia), citing “moderate degree of neuralgia.”  The VA did not address the right thigh condition.  The panel noted the EMG was normal and the pain lasted a few seconds to a few minutes per day and improved with sitting.  There was no evidence of severe cutaneous nerve impairment of the thigh that would denote the higher 10% rating.  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 thigh condition.  

Contended PEB Conditions:  Iron Deficiency Anemia and Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the right foot pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right lateral thigh pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended iron deficiency anemia and hypertension conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the Board’s scope of review for consideration.  
The panel, 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 20150617, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012108, 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,