RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01225
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic right foot pain” with a disability rating of 10%.  

CI CONTENTION:  Condition continues to worsen and negatively impact 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 - 20040915	VARD - 20050502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Foot	5099-5003	10%	Residuals, Right Foot Injury, Status Post Calcaneocuboid Joint Fusion, with Right Ankle Sprain	5284-5271	10%	20050405	
			Scar, Right Foot	7804	10%	20050405	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a calcaneocuboid joint fusion of the right foot on March 2004.  During the 16 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months before separation, the CI reported that she recently stopped using crutches.  Physical examination showed decreased ankle and foot range of motion (ROM), and a well-healed scar with numbness and decreased sensation in the lateral foot.  

The 11 August 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic right foot pain.  The CI constantly wore a controlled ankle motion (CAM) boot and used crutches intermittently.  X-rays showed the fusion position to be anatomic, with delayed bone healing.  Physical examination showed lateral foot edema (1+) and tenderness.  Sensation was intact aside from a decrease along the surgical scar.  Prognosis was considered good with a chance that additional surgery could be required if the joint failed to continue improving.  

At the 30 September 2004 physical therapy (PT) evaluation, 20 days prior to separation, the CI complained of continued right foot and ankle pain.  X-rays indicated no bony fusion present.  Physical examination showed a slow and guarded gait, right ankle decreased dorsiflexion strength (4/5), and ROM of 2 degrees of dorsiflexion (normal 20) and 45 degrees of plantarflexion (normal).  There was tenderness over the right lateral foot, slightly decreased scar mobility, and increased sensitivity over the scar.  

At the 5 April 2005 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported continued right foot pain (almost rated 10/10) with associated swelling.  She still wore a CAM boot regularly and could not stand or walk for over 10 minutes.  Physical examination showed normal posture and gait.  There was right ankle and foot tenderness laterally with a hyper-pigmented and tender scar.  Right ankle ROM was dorsiflexion of 15 degrees and plantar flexion of 35 degrees, with limited and painful inversion and eversion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot pain condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the right foot condition 10%, coded as 5284-5271 (other foot injury and limited motion of ankle), with an additional 10% rating, coded 7804, for a tender scar.  Both ratings were based on the C&P examination 6 months after separation, citing moderate limited motion of the ankle, and a scar which was painful on examination.  The panel consensus was that the NARSUM and 30 September 2004 PT evaluation had the highest probative value for rating at separation.  Members considered if the limitation of motion was “moderate” or “marked” when using code 5271.  The panel majority agreed the ROM examinations proximate to separation were consistent with the “marked” limitation required for the maximum 20% rating and were supported by the presence of an weakness, continued use of a CAM boot, and swelling.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  All panel members agreed that the impairment did not reach a  “severe” level to support a 30% rating under this code; however, the majority adjudged  that a 20% (“moderately severe”) rating using combined code 5284-5271 would most appropriately delineate the CI’s disability picture at separation.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the right foot pain condition, coded 5284-5271.  

BOARD FINDINGS:  In the matter of the right foot pain condition, the panel majority recommends a disability rating of 20%, coded 5284-5271 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  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 Pain, Right Foot…	5284-5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018949, 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