RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00497
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Master-at-Arms, medically separated for “severe pain and contracture of scar hypertrophied scar” with a disability rating of 20%.  

CI CONTENTION:  Review all 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 - 20051221	VARD - 20060712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Severe Pain and Contracture of Hypertrophied Scar	7899-7801	20%	Residuals, Status Post Subgerminal Correction, Right 2nd Metatarsal Head	5299-5283	20%	20060201	
Neuritis Second Toe at Metatarsophalangeal Joint Right Foot	Category II					
Mechanical Low Back Pain (LBP)	Category III	Scoliosis and Strain, Thoracolumbar Spine	5237	10%	20060201	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Severe Pain Right Foot and Contracture of a Hypertrophied Scar.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent remodeling surgery in April 2004 for hypertrophied bone of the second metatarsal head of the right foot.  The podiatrist noted a contracture of the EDL (extensor digitorum longus muscle) of the second toe of the right foot in October 2004.  The CI underwent a second surgery on 7 July 2005 and all scar tissue (contractions and adhesions) was excised.  By 9 August 2005 there was some scar tissue with contracture seen at the second metatarsophalangeal joint of the right foot.  The contracture and pain with dorsiflexion and plantar flexion persisted post-operatively.  

The 15 November 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of severe pain and contracture of a hypertrophied scar and neuritis of the second toe at the metatarsophalangeal joint of the right foot.  No physical examination was performed, but the 1 December 2005 MEB NARSUM examination showed a well-healed scar at the distal second metatarsal in which there was a bit of anesthesia around it.  

At the 1 February 2006 VA Compensation and Pension (C&P) evaluation, 3 days after separation, the CI reported pain in the right foot.  Physical examination showed tenderness of the second metatarsal.  There was guarding of the right foot with toe gait.  The Achilles tendon was well-aligned bilaterally.  Shoes did not demonstrate any evidence of unusual wear.  

At a podiatry clinic visit on 31 August 2006, 7 months after separation, there was tenderness on palpation of the right second metatarsophalangeal joint and pain was elicited by motion of the right foot.  Physical therapy did not resolve any pain or increase any motion.  At a podiatry clinic visit on 24 October 2006, 9 months after separation, the examiner assessed the condition as capsulitis (inflammation of the ligaments surrounding the joint) of the second right metatarsophalangeal joint.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 20%, coded 7899-7801 (scars, other than head, face, or neck, that are deep or that cause limited motion).  The Navy PEB also listed “neuritis second toe at metatarsophalangeal joint right foot” as a Category II condition, a diagnosis related to the primary unfitting diagnosis and not separately ratable (in accordance with VASRD §4.14, avoidance of pyramiding).  The VA also rated the right foot condition 20%, coded 5299-5283 (malunion or nonunion of tarsal or metatarsal bones), based on the C&P examination 3 days after separation, citing daily foot pain requiring the use of medications.  Panel members noted there was no evidence in the STR or VA examination to support a higher 30% rating under code 7801, which requires an area or areas of at least 72 square inches (465 square cm).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right foot condition.  

Contended PEB Condition:  Mechanical Low Back Pain (LBP).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the contended condition warranted placement on limited duty from 20 June 2004 through 21 July 2004 and was noted implicitly in a modified duty recommendations document dated 19 April 2005, the condition was not specifically implicated in the Non-Medical Assessment.  An MRI showed a subtle annular tear at the L4-5 level, but was otherwise unremarkable.  Electrodiagnostic testing was normal.  The 1 February 2006 C&P evaluation, 3 days after separation, noted the CI reported improvement in the back condition after walking, occasional yoga, and back extension exercises.  Thoracic discomfort, when present, resolved with rest.  She denied any incapacitating lumbar pain or the use of any assistive devices for her back.  There was no pain with active movement or with repetition and sensation was normal.  Panel members noted 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 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 right foot condition and IAW VASRD §4.118, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended back condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160811, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	
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Acting