RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00641
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic pain right foot” with a disability rating of 10%.

CI CONTENTION:  “Several issues have occurred that have been documented through the Veterans Affairs and the disability board in Nashville, TN.  The fact that my foot was fractured has caused me to have more problems in my hip and knee causing me to [have] significant pain in the foot and knee, most of the time where I cannot sleep.”  The CI’s 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 conditions 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 - 20031120	VARD - 20040522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Foot	5099-5003	10%	Fracture, 2nd Metatarsal, Right Foot	5299-5283	0%	20040424	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Pain Right Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in August 2003 while running during Basic Training.  Radiographic studies demonstrated a nondisplaced shaft fracture of the left second metatarsal.  A follow-up X-ray series on 27 August 2003 showed a minimally displaced fracture consistent with a stress fracture of the second metatarsal of the right foot.  On 8 October 2003, X-rays demonstrated exuberant callus present at the second metatarsal shaft fracture site and disuse osteopenia (demineralization of the bone) present at the second metatarsal shaft fracture site.  A podiatry note dated 20 October 2003 indicated the CI had a painful range of motion (ROM) of the right second digit and pain on palpation of the second metatarsal head and midshaft.  

During the 30 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported he fractured the second metatarsal of the right foot.  Physical examination showed tenderness on the dorsal and plantar aspects of the right foot over the second metatarsal without edema or effusion.  

The 30 October 2003 MEB NARSUM examination, noted complaints of right foot pain.  Physical examination showed tenderness to palpation both dorsally and on the plantar aspect of the right foot overlying the second metatarsal.  ROMs of the foot and ankle were full.  The CI was noted to have slight pes planus, but demonstrated good muscle strength and coordination.  There was no edema, effusion, or muscle atrophy.  Pulses were full and intact bilaterally.  Sensation to light touch and pin prick was intact and he had a normal gait.

At the 24 April 2004 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported occasional shooting pain from his toe up to the leg with standing or running, and was worsened with any repetitive stress on his feet.  Physical examination showed he had slightly flexible flat feet.  He was able to dorsiflex his ankles bilaterally to just past neutral and was able to plantar flex to 50 degrees.  There was no bony deformity present in his foot.  He had some mild tenderness to palpation about his second metatarsal.  He had no provocative signs of tarsal tunnel syndrome.  He had a normal gait with full sensation and normal reflexes that were symmetric throughout.  X-rays of the right foot dated 24 April 2004 demonstrated a tiny plantar spur off the calcaneus.  There was mature new bone formation along the shaft of the second metatarsal believed to be the sequela of a prior stress fracture in the area.  No acute fracture or dislocation was seen and no significant arthropathy was apparent.  The examiner opined that the CI had had a right second metatarsal fracture, but it had healed.  At a primary care visit on 20 December 2004 the CI stated he occasionally had residual mild pain in the foot with prolonged standing, but the pain was not severe enough to require medication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5099-5003 (arthritis, degenerative), citing slight and frequent pain IAW the U.S. Army Physical Disability Agency’s pain policy.  The VA rated the right foot condition 0% analogously coded 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of), citing subjective complaints of occasional pain without objective findings were “not indicative [of] moderate symptoms.”  Members discussed various coding options and agreed that code 5283 fit best with the CI’s history of a fracture of the second metatarsal; however, proximate to separation he had exuberant callus formation In October 2003 and by April 2004 there was mature new bone formation along the shaft of the second metatarsal believed to be the sequela of a prior stress fracture in the area.  Therefore, a rating of 20% for a moderately severe disability is not a viable rating option nor is code 5284 (foot injuries, other) at 20% for a moderate severe disability.  Use of code 5279 (metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral) at 10% offers no benefit to the CI.  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 right foot condition.  

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20160914, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016334, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure