RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00158
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, M1 Armor Crewman, medically separated for “chronic left foot pain status post [s/p] fracture of 5th metatarsal and two surgical debridements” with a disability rating of 10%.  

CI CONTENTION:  Review requested review of all conditions and 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 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 - 20041101	VARD - 20050127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain… 	5279	10%	S/P Fracture and Excision of Posterior Talus Process and Base of 5th Metatarsal, Left Foot	5299-5284	10%	20041201	
Right Shoulder Subacromial Impingement and Supraspinatus Tendinitis	Not Unfitting	Subacromial Impingement with Supraspinatus Tendinitis, Right Shoulder	5304	10%	20041201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left foot pain began in January 2004 after twisting it playing basketball.  Initially treated as a sprain, orthopedics eventually diagnosed non-union fractures in two separate areas of the left foot, and he underwent surgery on 20 May 2004 to remove bone fragments from the base of the fifth metatarsal and posterior process of the talus.  Complicated by a post-operative wound infection, he had a second surgery on 25 May 2004 to drain and clean out the infection.  Despite continued PT and rehabilitation, the CI’s foot pain remained.    

The 29 September 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of left foot and ankle pain.  Physical examination (PE) revealed left ankle range of motion (ROM) of dorsiflexion to 10 degrees (normal 20) and plantar flexion to 30 degrees (normal 45).  Additionally, his gait demonstrated a limp.    

At the 1 December 2004 VA Compensation and Pension (C&P) examination, 2 weeks prior to separation, the CI reported fairly constant left ankle pain and stiffness.  The PE revealed no swelling, redness, increased warmth, fatigue or weakness.  Left ankle ROM was measured at 15 degrees of dorsiflexion and 35 degrees of plantar flexion.  The examiner noted that the CI had demonstrated facial grimace (indication of pain) at end of inversion motion of the foot.   There was no change in ROM with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5279 (metatarsalgia, anterior), citing tenderness at the operative site and slight loss of ankle motion.  The VA also rated the left foot condition 10%, analogously coded 5299-5284 (foot injuries, other), based on the C&P examination, citing moderate foot injury.  Members first agreed that the VA examination was closest to separation and carried the greatest probative value.  Left ankle ROM demonstrated both limited and painful motion which was best assessed as “moderate” at 10% but well below “marked” (20%) under code 5271 (ankle, limitation of motion).  The panel concluded that although alternate and or more accurate coding was available, the maximum rating of 10% remained unchanged.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the left foot/ankle condition.  

Contended PEB Condition:  Right Shoulder Sub-Acromial Impingement and Supraspinatus Tendinitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The condition was profiled, implicated in the commander’s statement and judged to fail retention standards.  At the MEB examination, the CI demonstrated full, but painful motion of the shoulders and X-rays indicated degenerative joint disease about the acromial-clavicular joint within the right shoulder girdle.  At the C&P examination, he endorsed the inability to lift, carry or do physical training due to right shoulder pain.  The PE revealed decreased and painful ROM, and after repetition, right shoulder flexion was to 130 degrees (normal 180) and abduction to 135 degrees (normal 180).  Members considered the restrictive permanent profile, specifically noting the inability to perform push-ups and or any portion of the AFPT, and as such, agreed that the functional impairment of the right shoulder condition favors its recommendation as an additionally unfitting condition for a disability rating.  While the panel noted there was no limitation of shoulder motion to support a rating under code of 5201 (arm, limitation of motion), there was evidence of painful motion causing functional loss supporting a 10% maximum rating (based on §4.59, §4.40 and §4.45).  After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of right shoulder condition favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5099-5003 (analogous to degenerative arthritis) and meets the VASRD §4.71a criteria for a 10% rating.

BOARD FINDINGS:  In the matter of the chronic left foot pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended sub-acromial impingement and supraspinatus tendinitis , the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Foot Pain	5279	10%	
Right Shoulder Subacromial Impingement and Supraspinatus Tendinitis	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180012735, 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