RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX
	CASE:  PD-2015-01572
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “chronic pain, left foot," with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of all conditions. 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 - 20050826	VARD - 20060420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Foot…	5099-5003	10%	... Metatarsal Fusion of the Left Foot	5283	0%	20051129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI required surgery (intertarsal and tarsal-metatarsal fusion with pin fixation) for his left foot in 1998 (3 years prior to service entry).  As near as can be ascertained, this was not problematic at enlistment and did not surface until an acute onset of pain with an injury (details not in evidence) in April of 2005 (6 months before separation).  Imaging (X-ray and bone scan) demonstrated post-surgical degenerative arthritis with normal alignment and intact hardware.  The outpatient STR evidence probative to functional impairment, range of motion (ROM), and other VASRD rating criteria was consistent with that from the NARSUM and VA examinations which follow.  Podiatry opined that additional surgery was not indicated; a trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB.

The 17 August 2005 NARSUM examination, 2 months before separation, documented constant foot pain rated “7-9/10 depending on his activity” that prohibited running and most general soldiering requirements.  The physical examination recorded the use of a cane with an antalgic gait, metatarsal tenderness, and the absence of swelling.  The NARSUM referenced formal ROM measurements for the MEB by physical therapy on the same day.  These were dorsiflexion to 10 degrees (normal 20) and plantar flexion to 20 degrees (normal 45), specifying painful motion.

A 29 November 2005 VA Compensation and Pension (C&P) examination, 6 weeks after separation, documented “constant ... severe” pain exacerbated by prolonged standing or walking.  The physical examination recorded the use of a cane “to avoid falls and to take pressure off left foot,” but a normal posture and gait.  The examiner noted “signs of abnormal weight bearing” (callosities), but specified the absence of tenderness, swelling, or malalignment.  Measured ankle ROM was normal in all planes, but pain with repetition was specified.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot pain condition 10%, analogously coded as 5003 (degenerative arthritis) citing the “slight/constant” criterion of the U. S. Army Physical Disability Agency pain policy, although the service evidence was also consistent with VASRD §4.71a criteria for that code.  The VA rated the left foot pain condition 0%, coded 5283 (tarsal or metatarsal malunion or nonunion) based on the C&P evidence, citing the failure to satisfy the minimum 10% criterion of “moderate” disability.   

Code 5283 additionally offers ratings of 20% for “moderately severe” and 30% for “severe” disability; but, members agreed that the functional evidence (disability confined to more strenuous activities) would not support a recommendation for a rating under 5283 higher than 10%.  Code 5284 (foot injuries, other) could be considered, but the rating criteria and scale are equivalent to that for 5283; and, likewise code 5279 (metatarsalgia) could be considered, but offers a maximum rating of 10%.  Finally, members considered rating under code 5271 (limited motion of the ankle) that confers a 20% rating for “marked” limitation, but agreed that this criterion could not be supported by the above ROM evidence which indicated that ROM was normalizing by the time of separation.  No other criterion was supported by the evidence that would justify a rating higher than 10% under any applicable 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 of the left foot condition.

BOARD FINDINGS:  In the matter of the left foot pain 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 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008531, 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