RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00010
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040811

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

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 - 20040608	No VA Rating Decision in Evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain	5099-5003	0%		
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’s left foot pain began in August 2003 while running on a treadmill which resolved after rest.  Then in November 2003 the CI slipped from a ladder while deployed to Afghanistan and left foot pain returned.  X-Rays were negative for fracture and there was no surgical indication and despite 8 months of conservative treatment including medication and prescription of a controlled ankle movement (CAM) walker for 2 weeks, the CI’s left foot pain did not sufficiently improve to allow unrestricted duty.  

At the 26 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain in his left foot that caused him to not be able to stand correctly on that foot.  Physical examination showed pain on palpation of the dorsal surface of the left foot with decreased range of motion (ROM) (which joints were not specified) and pain with all ROM movements.  A nuclear medicine bone scan performed 2 March 2004, 5 months prior to separation, showed no increased uptake in the area of tenderness.  

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot pain 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing “pain on the dorsal surface as well as pain with ranges of motion.”

There was no evidence of acquired flatfoot or claw foot to rate under the respective codes (5276, 5278).  The panel noted that it was possible to rate this condition using code 5279 (metatarsalgia, anterior, unilateral or bilateral) for a maximum of 10%.  There was no evidence of hammertoe (5282), fracture with malunion or nonunion of a tarsal or metatarsal bone (5283) and the panel judged that the severity of the CI’s condition did not rise to the level of “moderate” to satisfy the requirement of code 5284.  There was evidence of painful motion with functional loss supporting a minimum 10% rating (based on §4.59, §4.40 and §4.45).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left foot pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left foot pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  

There are 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Foot Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151227, with attachments
Exhibit B.  Service Treatment Record

AR20170013180, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,	
Enclosure