RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01955
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Information Management Apprentice, medically separated for “chronic left foot pain,” with a disability rating of 10%.

CI CONTENTION:  “Still have chronic pain in foot and ankle.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20070524	VARD – None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain…	5299-5279	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

Chronic Left Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s persistent left foot pain condition began in July 2006 after she jumped off a wall during warrior challenge while in boot camp.  X-rays of the left foot showed an accessory navicular bone which could cause pain.  Conservative measures did not relieve the pain.  She had pain in the same area for a short time while in high school.  The MEB forwarded “chronic left foot pain” for PEB adjudication.  

An orthopedics addendum, dated 21 December 2006, 7 months before separation, noted the CI did not have swelling recently but had increased pain upon movement of her foot.  She was wearing foot orthotics all day on weekends and about 5 hours during the week.  With the orthotics she did not have pain.  She could not fit the orthotics into her work boot.  She was unable to run for exercise or do pushups.  Pain went to 8 out of 10 with inversion and eversion of the foot.  She was exempt from running for the fitness test.  Exam of the left foot showed mild swelling on the medial aspect of the left mid foot over the navicular and posterior tendon area.  The medial arch was moderately decreased with weight bearing and the there was a moderate amount of excessive pronation.  There was tenderness over the navicular bone.  Pain was elicited with motion of inversions and eversion.  Gait was normal with exception of excess pronation of her feet, left worse than right.  The bone had not responded to treatment with a walker, cast boot, medication and custom orthotics.  Surgical excision was recommended.   The examiner noted the condition was preexisting.  

The MEB NARSUM examination on 17 January 2007, 7 months prior to separation, noted the CI was taking pain medication 4 times per day.  She was performing desk duty.  Examination of left foot showed range of motion (ROM) limited to 15 degrees plantar and dorsi flexion while the right foot had a full ROM.  There was tenderness in left mid foot with rotation.  Strength was 5/5 and deep tendon reflexes were normal.  A VA Compensation and Pension (C&P) evaluation was not in evidence.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic left foot pain condition 10%, analogously coded 5299-5279 (metatarsalgia, anterior (Morton’s disease), unilateral), citing service aggravation of a pre-existing condition.   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.  

BOARD FINDINGS:  In the matter of the chronic left foot pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. The Board, 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 20150627, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01955.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings