RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01801
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “bilateral fifth metatarsal pain,” with a disability rating of 10%.   

CI CONTENTION:  The CI contends he would have met the 30% rating or higher with all his medical 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 - 20070511	VARD - 20070905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Fifth Metatarsal Pain…	5299-5279	10%	Left Foot 5th Metatarsal Fracture…	5299-5280	10%	20070618	
			Right Foot 5th Metatarsal Fracture…	5299-5280	10%	20070618	
			Right Foot…Scar, S/P Osteotomy	7805	0%	20070618	
			Right Foot…Scar, S/P Osteotomy	7805	0%	20070618	
PTSD	Not Unfitting	Anxiety d/o, NOS 	9413	10%	20070622	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

Bilateral Fifth Metatarsal Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery in March (left foot) and August (right foot) 2006 to correct bunions on the fifth metatarsal (ie, the little toe).

The 10 January 2007 MEB NARSUM examination, 8 months prior to separation, noted complaints of an inability to run without severe increase in daily pain.  Walking and marching greater than one mile severely increased pain.  Non-steroidal medications did not reduce the pain.  Physical examination showed a 4 centimeter (cm) surgical scar at the distal left fifth metatarsophalangeal joint (MTP; the joint at the ball of the foot) and 5 cm surgical scar at the distal right fifth MTP.  There was no bunion on either foot with excellent surgical appearing fifth MTP joints, no swelling, pain along surgical scars or pain with squeeze test, and no pain with toe raising.  Pulses and sensation were intact.  A March 2007 Podiatry examination, 5 months prior to separation, noted moderate tenderness along the bottom outside of the foot with minimal swelling.  There was moderate limitation of range of motion (ROM) with dorsiflexion secondary to scar tissue adhesions of the joint capsule.  The examiner noted the CI had difficulty tolerating boots and training with his unit for MOS related activities.  

At the 18 June 2007 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported pain two to three times per day for a few minutes rated 3/10 in severity, elicited by physical activity and relieved by rest.  He could function without medication.  Physical examination of the feet and toes showed 4 cm well healed scars on the lateral (outside) aspect of the feet.  Sensation and pulses appeared intact.  There was no sign of painful motion, swelling, weakness, atrophy or tenderness with intact arches.  There was no evidence of claw feet or hammertoes.  There was no pain on flexion or dorsiflexion of the toes and there was no evidence of Morton’s metatarsalgia (pain under the metatarsal bones.)  He did not use corrective shoe wear.  The pain did not affect his functioning in his usual occupation or his activities of daily living.  A diagnosis of bilateral fifth metatarsal fractures by x-ray was rendered.  There was no disfigurement or complications identified.  Right foot x-ray showed an old healed fracture with orthopedic repair in the mid diaphyseal portion (long bone) of the right fifth metatarsal.  Left foot X-ray showed an old healed fracture with orthopedic repair involving the distal diaphyseal portion of the left fifth metatarsal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain condition 10%, coded analogously to 5279 (metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral), citing chronic bilateral fifth metatarsal pain, status post bilateral tailor bunion surgery, with high impact activity.  The VA rated the bilateral foot pain condition with separate ratings for the left foot and right foot at 10% each, both coded analogous to 5280 (unilateral hallux valgus) citing bilateral resection of the metatarsal head. There was no evidence of moderately severe foot injuries (5284) or of claw foot (5278) or of severe pes planus (5276.) The Board could not find a pathway to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left foot pain condition.  

Contended PEB Condition:  Posttraumatic Stress Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral foot pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150624, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170009094, 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,					      
						      					
Enclosure