RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01571
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fire Fighter, medically separated for “right foot pain” with a disability rating of 10%. 

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031107	VARD - 20040506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Foot	5099-5003	10%	Freiberg Infarction with Previous Surgery, Right Foot	5283	10%	20040318	
	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Foot.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s right foot was re-injured in July 2001 during physical training while running.  At the time, the CI hyperextended his second toe metatarsophalangeal joint (MTP).  In October 2001, the CI underwent a second metatarsal cheilectomy for osteonecrosis (Freiburg infraction).  Following surgery, the CI remained pain-free for a month before his pain returned.  Despite being provided inserts and medication, the pain persisted.  
The 1 October 2003 MEB NARSUM examination, 3 months prior to separation, noted complaints of right second toe pain.  The CI noted despite shoe wear modification and inserts , he continued to have pain which prevented running, walking, biking, swimming, and performing the physical fitness test.  Physical examination showed a well-healed dorsal scar with a positive Tinel (detect irritated nerves), which had caused most of his symptoms (nerve irritation).  He had 0 degrees of plantar flexion in his second MTP joint, and dorsiflexion of 45 degrees.  Radiographs showed degenerative changes.

During the 20 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported he had pain in his right foot, and surgery had limited walking, and running.  He was not able to stand on his right foot.  Physical examination showed tenderness in the dorsal aspect of the right foot and a surgical scar.  Foot arches were normal.

At the 3 March 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported continued pain at the base of his second toe.  Physical examination recorded a well-healed scar over the right second MTP, and tenderness in the joint.  Range of motion was “80% decreased.”  He was able to complete a normal toe-off, but was tender.  The examiner noted x-rays that demonstrated narrowing of the MTP space, which was believed to be the cause of his pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded analogously 5099-5003 for pain.  The VA also rated the right foot condition 10% coded 5283 (malunion or nonunion of metatarsal bones, moderate).

The higher rating of 20% under the 5003 code requires episodes of incapacitating exacerbations with prescribed bedrest, evidence of this was not present.  The panel also noted a higher rating was not obtainable under code 5279 (morton’s disease) since 10% is the highest rating under that code, and higher ratings were not obtainable under codes 5284 (foot injuries, other), or 5283 since the CI was able to complete a normal toe-off, and was able to ambulate without assistive devices.  His profile allowed for walking and swimming at own pace and unlimited biking.  Panel members concluded, his condition did not justified the higher rating of 20% for moderately severe symptoms, under either codes.  The panel next considered code 5310 (group X function: movement of forefoot and toes), and was unable to justify the 20% level for moderately severe symptoms based on the findings at the NARSUM and C&P examinations.  There is no route to a higher rating under any applicable code.  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 pain condition.  

BOARD FINDINGS:  In the matter of the chronic pain, right foot condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends 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 20161007, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005204, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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