RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01375
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policewoman, medically separated for “low back pain” and “foot injury,” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  The VA gave a higher rating.  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031110	VARD - 20040218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5237	10%	Residual of Low  Back Injury	5237	10%	20031120	
[Right] Foot Injury	5284	0%	Right Foot Sesamoiditis with Pes Planus	5276-5284	10%	20031120	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in December 2001 while playing basketball.  The CI was treated conservatively with no further problems until September 2002 when she sustained a twisting injury to the back.  A bone scan showed no abnormalities in the lumbosacral spine, but an MRI showed multiple small disc bulges from L2-S1 without impingement of nerve structures.  

The 9 July 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of LBP aggravated by prolonged standing, bending, running, walking (prolonged periods), or any sport activity.  Physical examination showed the CI was able to bend forward to approximately 30 cm off the floor (approximately 12 inches, which converts to 70-80 degrees of forward flexion (normal 90)) and hyperextend (extend) to 25-30 degrees (normal 30).  She could lateral bend to 10 cm above the fibular head on the right and to the fibular head on the left.  She could also rotate with her shoulders at 90 degrees to the pelvis on the right and left.  Straight leg raise testing was 90 degrees on the right and left.  Heel/toe action was normal.  

At the 20 November 2003 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported LBP after prolonged sitting.  Physical examination showed normal posture and gait.  Range of motion (ROM) testing showed flexion of 85 degrees (normal 90) and combined ROM of 205 degrees (normal 240).  There was no evidence of abnormal spinal contour.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing guarding.  The VA also rated the back condition 10%, coded 5237, based on the C&P examination 2 months before separation, citing decreased and painful motion.  The panel agreed a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees as reported on the VA examination proximate to separation.  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 back condition.  

Right Foot Injury.  According to the STR and MEB NARSUM, the CI’s right foot condition began in June 2002 following a basketball injury.  A 2 August 2002 orthopedic evaluation noted a flat right foot with heel tenderness.  A diagnoses of plantar fasciitis and flat foot deformity were rendered. An X-ray taken on 27 September 2002 was normal.  

The 9 July 2003 MEB NARSUM physical examination, 6 months prior to separation, showed an antalgic gait on the right side related to foot pain.  The examiner opined that pes planus was asymptomatic, but productive of planter fasciitis (inflammation of the lining of the foot) and “possibly” causative of sesamoiditis.  An undated orthopedic note documented a fractured right sesamoid bone in November 2002, which was treated with a soft cast for 2 months.  The examiner noted the CI was still being treated with physical therapy and new inserts and opined the CI was “dealing with constant inflammation in her foot.”  

At the 20 November 2003 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported persistent right foot pain.  The examiner noted the CI was able to walk up to 2 miles at a time and work out for 25 minutes on a treadmill, but was unable to run.  Physical examination showed mild pes planus, discomfort along the plantar fascia and an antalgic gait on the right side due to her foot.  There was tenderness to palpation around the sesamoid bone.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 0%, coded 5284 (foot injuries, other), citing slight disability.  The VA rated the right foot condition 10%, coded 5276-5284 (pes planus-foot injury), based on the C&P examination 2 months before separation, citing “tenderness to palpation over the plantar fascia and…an antalgic gait.”  Panel members noted both the NARSUM and VA examinations documented an antalgic gait, plantar tenderness to palpation and tenderness over the right sesamoid bone.  Panel members agreed the evidence supported a 10% under several VASRD codes:  metatarsalgia (5279), pain on manipulation and use of the foot (5276) and moderate foot injury (5284).  There was no evidence of a moderately severe foot injury or severe pain on manipulation or use, to support a higher rating.  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 5284.  
BOARD FINDINGS:  In the matter of the back condition, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right foot condition, the panel unanimously recommends a disability rating of 10%, coded 5284 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5237	10%	
Right Foot Pain	5284	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161002, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001408, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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