RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00575
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051125

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

CI CONTENTION:  “The right foot crushing injury.”  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 - 20051013	VARD - 20060629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Metatarsalgia, Right Foot	5279	10%	Residuals, Right Foot Crush Injury	5299-5284	10%	20060525	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Foot Metatarsalgia.  According to the service treatment (STR) record and MEB narrative summary (NARSUM), the CI suffered a right foot crush injury in May 2001 resulting in a minor fracture (proximal phalanx great toe, non-displaced) that was treated conservatively (toe splint).  He subsequently reported worsening pain, but the STR contained sporadic requests for profile updates and documented only localized tenderness with full range of motion (ROM).  There was no mention of gait disturbance until he presented in July 2005 complaining of severe pain without report of any new injury or other exacerbation.  The commander’s performance statement noted that this coincided with a pending unit deployment and that the CI “needed a cane to assist him with walking and he had a distinct limp that was not there a day prior.”  An X-ray was normal, and an MRI revealed only localized degenerative changes around the first and fifth toes.  

The 8 August 2005 MEB NARSUM podiatry examination documented constant pain rated at 8/10 that was “worse with wearing of military boots and with increased weightbearing activities such as running, rucking, marching and jogging.”  The physical examination recorded “minimal” dorsal swelling, tenderness over the first three metatarsals and proximal toe joints, pain with motion of the same toes, and “decreased” ROM at the great toe.  The podiatry diagnosis was "metatarsalgia
[and neuralgia] of the right foot as a result of crush injury."

The 21 September 2005 MEB NARSUM examination, 2 months prior to separation, recorded persistent, nonspecific foot pain, and noted that the CI “now also walks with a cane, which he states is used to protect his left hip from over burden from favoring his right foot.”  Documented functional limitations included an inability to “lift any significant weight,” run, or do push-ups, but probative physical findings were not recorded.  The examiner referenced the commander’s opinion that the “injuries are exaggerated to some extent” and medically opined that “his symptoms seem out of proportion to the physical findings observed, as well as to the diagnostic studies performed.”

The 25 May 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, documented intermittent pain and stiffness characterized as “moderate.”  Specific functional limitations of the foot were not elaborated.  Physical examination revealed an antalgic gait with the use of a cane (mitigated by concurrent complaints of back and bilateral knee and hip pain) and dorsal foot tenderness.  There no noted swelling or deformity, and ankle ROM was dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal), with painful motion.  Foot and phalangeal ROM were not documented.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot metatarsalgia 10%, coded 5279 (metatarsalgia), citing no improvement with therapy and continued symptoms.  The VA rated right foot crush injury residuals 10%, coded 5299-5284 (analogous to foot injuries), based on the on the C&P examination, citing applicable criterion of “moderate” disability.  Members considered a higher rating under code 5284, but agreed that the disability in evidence, especially considering the objective clinical acuity, was more reasonably characterized by a “moderate” 10% rating rather than “moderately severe” 20% rating.  Other than consideration of a higher rating under code 5284, there were no evidence of any deformity or additional VASRD-ratable findings suggesting any alternate foot diagnosis to justify a rating higher than 10%.  Analogous rating under code 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of) was considered, as was ankle limitation of motion, but neither was advantageous to the CI; members agreed code 5279 was a good clinical match for this case.  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 of the right foot condition.

BOARD FINDINGS:  In the matter of the right foot metatarsalgia and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, 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 20170207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007701, 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