RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-02431
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090117

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “left foot pain” with a disability rating of 10%.

CI CONTENTION: The CI made no specific contention. 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 at the time of separation. The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation. 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 - 20081106		VARD - 20090826	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Metatarsalgia of the Left Foot	5279	10%		Status Post Left Foot Dorsal Arthrotomy with Scar	5284	0%	20090327	
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Metatarsalgia of the Left Foot. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed atraumatic left foot pain in 2006 that was diagnosed as a Morton’s neuroma (painful benign nerve tumor). He underwent surgical excision of the neuroma in May 2007 (20 months before separation), and required surgical drainage for complications (non-compliance a significant factor) a month later, with no further complications.

There was ample STR documentation of grossly normal range of motion (ROM) of the ankle and foot with no contrary entries. There was intermittent documentation of gait disturbance (normal in some entries, antalgic in others), but there was no documentation of any additional VASRD-

ratable findings or ratable foot diagnoses except for congenital pes cavus (not service acquired and not meeting minimum 10% criteria). The NARSUM examination (by podiatry, date illegible) documented non-specific left foot pain interfering with standing (shifting weight to heel) and walking (foot supination to minimize pain). The physical examination recorded “significant” tenderness over the surgical site without swelling or other tenderness, and intact neurovascular findings. There was no comment regarding ROM. The 27 March 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, documented constant bilateral foot pain rated 5/5 that was aggravated by standing or walking; although, the examiner later stated paradoxically that there was “no functional limitation of standing or walking.” The physical examination recorded a normal gait, no swelling, no tenderness, no weakness, no malalignment or deformity, and intact neurovascular findings. The VA examiner also did not provide any evidence probative to ROM.

The panel directed attention to its rating recommendation based on the above evidence. The PEB’s 10% determination was consistent with the only rating offered under its code 5279 for “metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral.” The VA’s 0% determination under code 5284 (foot injuries, other) was based on the C&P evidence and cited failure to meet the “moderate” criterion for a 10% rating under that code. Code 5284 offers ratings of 20% for “moderately severe,” and 30% for “severe,” disability.

Other than consideration of higher rating under the above criteria of code 5284, no criterion was supported by the evidence that would justify a rating higher than 10% under any other applicable code available in VASRD §4.71a. The panel noted, however, that the PEB code 5279 is quite specific for the condition under consideration; and, agreed that no alternative code was reasonably justified, even for analogous rating. Furthermore, even if rating under code 5284 were conceded (analogously since there was no injury), members agreed that the functional evidence did not support a rating higher than 10% under those criteria (above). 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 metatarsalgia of the left foot 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 20151007, w/attachments Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012914, 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,