RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00720
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Airman Apprentice, medically separated for “mild deep peroneal nerve neuropraxia, right foot” with a disability rating of 0%.  

CI CONTENTION:  Her foot condition has worsened since discharge, and she listed other conditions including right knee pain, hips, compression of the spinal cord, hearing, severe anxiety, depression, and MST.  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 (VA), 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 - 20040112	VARD - 20050426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Deep Peroneal Nerve Neuropraxia, Right Foot	8723	0%	Residual Right Foot Injury with Peroneal Neuropathy and Scar	5284-8723	10%	20041021	
Mild Reflex Sympathetic Dystrophy of Right Foot	Cat II					
Presence of Exostosis, Right Foot, Status Post Surgical Resection	Cat II					
Right Fifth Metatarsal Fracture, Healed	Cat III					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Mild Deep Peroneal Nerve Neuropraxia, Right Foot.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began after sustaining a right fifth metatarsal (little toe) fracture in February 2002, with development of an exostosis on the top of her foot.  She underwent surgery (exostectomy) in June 2003.  She developed neuropraxia of the deep peroneal nerve related to her surgery with chronic right foot pain.  

The 21 October 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of right foot pain, with inability to tolerate military footwear, sensitivity over the dorsum of the right foot and numbness of the first and second toe at the first web space.  Physical examination showed a well healed 3 cm surgical scar over the mid foot, with mild, non-blanching erythema, and sensitivity to touch.  There was no swelling or other skin changes.  The first web space had decreased light touch and motor strength was normal.  

During the 31 October 2003 and 13 November 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 to 4 months prior to separation, the CI reported right foot surgery and foot pain.  The examiner’s summary was similar to the NARSUM indicating mild reflex sympathetic dystrophy (RSD) and mild deep peroneal nerve neuropraxia.  Physical examination showed weak dorsiflexion of the right foot and great (1st) toe with decreased sensation across part of the first two digits.  A right foot scar was noted without details.  The 3 November 2003 memorandum from the medical hold company indicated that the CI was undergoing orthopedic treatment with over 6 appointments weekly.  She could wear shoes for no more than 2 hours at a time and was prescribed by her physician to wear sandals.  

At the 21 October 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported right foot pain, weakness, swelling with activity, and difficulty wearing running shoes or boots.  She indicated that she could not move her right big toe and had tingling and numbness.  Physical examination showed a normal gait.  The right foot had a soft elevated, non-tender hypopigmented scar and mild hallux valgus with no evidence of painful motion or edema.  The right big toe had painful limited motion to 5 degree dorsiflexion and 5 degrees plantarflexion.  The right ankle had dorsiflexion to 20 degrees (normal) and plantar flexion to 30 degree (normal 45) with painful motion.  Sensation was decreased to pinprick in the right fourth and fifth toes.  The diagnosis was “status post right foot fracture, requiring excision of the exostosis and spongy tissue with residual non-disfiguring scar; hyposensitivity, right fourth and fifth toes; pain; limited range of motion of the right ankle; deep peroneal neuropraxia of the right foot, and limited range of motion of the right big toe.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 0%, coded 8723 (neuralgia of the anterior tibial nerve (deep peroneal)).  The PEB listed mild reflex sympathetic dystrophy of right foot, and presence of exostosis, right foot, status-post surgical resection, as related diagnoses (Category II) contributing to the disability in this case.  The PEB’s Category II diagnoses are intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14- avoidance of pyramiding); thus, they are appropriately subsumed under the same rating.  The VA rated the right foot condition 10%, coded 5284-8723, (foot injuries, other, with neuralgia of the anterior tibial nerve (deep peroneal)), based on the C&P examination 7 months after separation, citing incomplete paralysis of foot movements which was moderate.  

The panel deliberated if the CI’s right foot disability including the mild deep peroneal neuropraxia, mild RSD, and exostosis conditions more nearly approximated the next higher 10% (moderate) rating criteria under code 8723 (the maximum rating IAW VASRD §4.124), or met the 10% rating criteria under analogous code 5284.  Given the combined diagnoses, weakness at the MEB and VA examinations, tenderness/sensitivity impacting the inability to wear military foot gear, and the totality of the record, the panel adjudged that the CI’s disability picture more nearly approximated the 10% moderate neuralgia criteria.  Predominate coding was 5284-8723.  The panel considered alternative ratings analogous to 5284 (foot injuries, other), but the evidence did not more closely approximate the next higher 20% criteria of a moderately severe foot injury.  There was no other pathway to any rating higher than 10%.  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 right foot condition, coded 8723-5284.  

Contended PEB Condition:  Right Fifth Metatarsal Fracture, Healed.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the Right Fifth Metatarsal Fracture was the precipitating condition for surgery and the unfitting right foot condition (above), the fifth toe was healed by the time of separation.  Examination did not document any separate duty limiting disability from the healed fifth metacarpal fracture.  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, the panel unanimously recommends a disability rating of 10%, coded 5284-8723 IAW VASRD §4.71a and §4.124a.  In the matter of the contended healed right fifth metatarsal fracture condition, the panel unanimously agrees it cannot recommend it for additional disability rating.  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	
Mild Deep Peroneal Nerve Neuropraxia, Right Foot with Mild RSD and Exostosis	5284-8723	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		     COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	 (b) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (g) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX    
	 (h) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (i) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.
    
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.