RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00062
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030806

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, 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(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 - 20030403	VARD - 20030807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain 	5399-5310	10%	Status Post  Plantar Fascial Release…with Post-Operative Residuals	5284	10%	20030529	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Foot Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had post-traumatic changes to his left great toe joints in 2000.  He underwent multiple surgeries, with the last surgery in April 2002 for fusion of the left hallux (great toe) interphalangeal joint (for malunion) and left instep plantar fascial release.  The MEB forwarded “left foot pain status post hallux interphalangeal arthrodesis” and “left plantar fasciitis” for PEB adjudication.  

The 12 March 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of left plantar fasciitis and left distal hallux pain with inability to wear boots, and no response to left foot inserts.  Physical examination showed left foot tenderness along the plantar medial aspect of the heel.  There were well-healed surgical scars at the plantar medial heel, the dorsal great toe interphalangeal joint, and the distal great toe with decreased sensation around the scars.  Otherwise, neuro vasculature was intact throughout.  He had normal range of motion (ROM) at the metatarsophalangeal joint and 0 degrees ROM at the interphalangeal joint.  Podiatry examination also noted tenderness at the plantar fascial band with well-healed scars, and noted palpable hardware and slight weakness (4+/5) plantar flexion, dorsiflexion and inversion of the foot.  X-rays showed normal-appearing healing of the great toe fusion.  

At the 29 May 2003 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported left foot pain, weakness, stiffness and fatigue at rest; which worsened with standing and walking and included swelling.  He noted inability to walk for any distance, stand for prolonged periods, or run.  He also had continued left great toe pain and inability to wear boots.  Physical examination showed a normal gait as well as a guarded gait secondary to subjective pain in the left great toe.  The CI was “unable to walk on his heels and toes without difficulty secondary to subjective pain” in the heel and toes.  The left foot had well-healed surgical scars and a tender heel.  There was good weight bearing alignment of the left Achilles tendon.  Left great toe dorsiflexion and plantar flexion was compromised and pain disrupted ROM.  There was no neurovascular deficit and reflexes, sensation and motor strength were normal.  X-rays showed flatfoot deformity with arthrodesis at the left great toe with an orthopedic screw.  The diagnosis was status post plantar fascial release of the left foot and surgical repair for mobilization of the left great toe fracture with bilateral plantar fasciitis and pes planus.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot pain condition 10%, coded 5399-5310 (analogous to group X muscle function), citing foot pain with a normal arch and analogous rating per DOD instructions.  The VA also rated the left foot pain condition 10%, coded 5284 (foot injuries, other), based on the VA C&P examination 2 months before separation, citing foot injury resulting in moderate symptoms.  The panel adjudged that the CI’s symptoms did not rise to the level of “moderately severe” for the next higher rating under either code 5310 or 5284.  There were no other codes under either VASRD §4.71a or §4.73 which provided any higher rating than that awarded by the PEB.  

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 for the left foot pain condition.  

BOARD FINDINGS:  In the matter of the left foot pain condition and IAW VASRD §4.73, 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 20160208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013216  , 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,