RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01766
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic left foot pain” with a disability rating of 0%.

CI CONTENTION:  The CI requested the panel to consider his osteoarthritis.  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 - 20050722	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain 	5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:  

Chronic Left Foot Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an onset of left foot pain with running during a 2004 deployment to Iraq.  The pain persisted upon redeployment, and radiographic (X-ray) and computerized tomography (CT) scan demonstrated mild degenerative changes only.  Clinical STR entries documented grossly normal range of motion (ROM) of the ankle and mid-foot, although painful motion was specified by some examiners.  There were no entries that suggested any significant ROM limitation or functional impairment, or that documented any additional VASRD-ratable diagnoses or findings.  The 23 May 2005 NARSUM examination, 4 months prior to separation, documented pain rated “slight/frequent” that prohibited “running, jumping, prolonged standing or marching and heavy lifting.”  The physical examination recorded a normal gait, “mild” metatarsal tenderness, and a stable ankle joint.  Measured ROM at the ankle was dorsiflexion to 9 degrees (normal 20) and plantar flexion to 34 degrees (normal 45), specifying painful motion.  The examiner also noted “good” ROM at the subtalar and mid-tarsal joints.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating under code 5003 (degenerative arthritis), citing the NARSUM ROM measurements without articulating a specific rationale; and, it was noted that the VASRD §4.59 (painful motion) provision for the minimum rating (10%), as stipulated in VASRD §4.71a for code 5003, was not conceded by the PEB.  Members agreed, however, that there was satisfactory evidence of painful motion, in STR entries as well as the NARSUM, in support of the application of §4.59. 

Furthermore, code 5279 (metatarsalgia) was also considered to be a good analogous fit with the pathology and disability; and, with concession to VASRD §4.7 (higher of two evaluations), would support a 10% rating without regard to other criteria.  Another consideration for analogous rating was code 5284 (foot injuries, other), but members agreed that the functional disability in evidence would not justify a rating higher than the 10% criterion of “moderate” disability.  Finally, code 5271 (limited motion of the ankle), even though the 20% criterion of “marked” limitation was not supported by the ROM evidence, the evidence would reasonably support the 10% rating for “moderate” limitation (or by application of §4.59 independently of the ROM criterion).  There are no other codes available under §4.71a that are applicable to this case, even for analogous rating.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the left foot condition under code 5010-5271 (traumatic arthritis rated for limited motion).

BOARD FINDINGS:  In the matter of the chronic left foot pain condition, the panel unanimously recommends a disability rating of 10%, coded 5010-5271 IAW VASRD §4.71a.  There were 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 his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Traumatic Arthritis, Left Foot	5010-5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, with attachments
Exhibit B.  Service Treatment Record

	
AR20170008801, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
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,