RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-01481
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070616

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “left ankle pain” and “bilateral foot pain” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 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 - 20070504	VARD - 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain…and Bilateral Foot Pain	5099-5003	10%	Residuals, Talofibular Ligamentous Tear, Left Ankle	5299-5271	10%	20070801	
			Residuals, Plantar Warts, Bilateral Feet	7899-7813	0%	20070801	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a left ankle inversion sprain in January 2006 and X-rays revealed a torn anterior talofibular ligament. Surgical repair was offered, but the CI declined. At the 9 January 2007 orthopedic evaluation, 5 month prior to separation, the CI reported severe left ankle pain with giving way. Physical examination showed mild swelling, a significant reaction to light palpation, painful motion, and an antalgic gait.

The 13 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, noted left ankle tenderness, and the 11 April 2007 MEB NARSUM examination, showed pain with palpation, unstable single rim stance, and anterior instability. There was full ankle range of motion, but painful motion was not addressed.

At the 1 August 2007 VA Compensation and Pension (C&P) examination, 2 months after separation,  the  CI  reported  chronic  pain  when  walking,  intermittent  limping,  swelling with

activities, and the use of two ankle braces (rigid and soft). Physical examination showed painful motion, limitation of dorsiflexion to 15 degrees (normal 20), and limitation of plantar flexion to 35-40 degrees.  The examiner noted “a limp favoring the left side.”

The panel first considered whether the left ankle condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting. The left ankle was profiled, implicated in the commander’s statement and failed retention standards. Thus panel members concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the bundled left ankle condition was reasonably considered separately unfitting.

The panel then considered its rating recommendation for the unfitting left ankle condition at the time of separation. The PEB bundled and rated the left ankle and bilateral foot condition 10%, analogously coded 5099-5003 (degenerative arthritis). The VA rated the left ankle condition 10%, coded 5299-5271 (limitation of ankle motion), based on the C&P examination 2 months after separation, citing “limitation of motion as a result of pain.” Panel members noted that the preponderance of evidence documented painful motion, pain with use and instability, and thus concurred that a 10% rating was supported based on functional loss (§4.40, §4.45, and §4.59) due to instability and pain. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left ankle condition, coded 5299-5271.

Bilateral Foot Pain. According to the STR and MEB NARSUM, the CI was diagnosed with plantar verruca (warts) and underwent debridement of multiple plantar warts on each foot in October 2006 and February 2007. The MEB NARSUM examination, 2 months after surgical excision, showed “multiple verruca type masses on bilateral feet particularly at the metatarsal heads bilaterally.” The 26 April 2007 PEB- directed physical examination showed healing surgical scars with moderate tenderness of the scabbed areas. The examiner noted that both feet were still painful, left greater than right.

At the C&P examination the CI reported plantar warts which were painful with weight bearing. Physical examination showed scarring of the feet at the surgical sites, which were red (erythematous) with irregular scaling but “not particularly tender.” There were several plantar warts on each foot.

The panel considered whether the bilateral foot condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting. Although the bilateral foot condition was not implicated in the commander’s statement, it was profiled and failed retention standards. Panel members concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that the bundled bilateral foot condition was reasonably considered separately unfitting.

The panel then considered its rating recommendation for the unfitting bilateral foot condition at the time of separation. The PEB bundled and rated the bilateral foot and left ankle condition as noted above. The VA rated the bilateral foot condition 0%, coded 7899-7813 (dermatophytosis), based on the C&P examination, citing “evidence does not show involvement of at least 5%, but less than 20%, of the entire body, at least 5%, but less than 20%, of exposed areas affected, or a requirement for intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, for a total duration of less than 6 weeks during the past 12-month period.” Although the MEB and PEB directed examinations demonstrated tenderness and pain in each foot, panel members noted that these examinations were just 2 months after surgery, and thus placed higher probative value on the VA examination which was performed 6 months after surgery and 2 months after separation. The panel noted that the VA rating analogous to dermatophytosis  allowed  for  rating  the  condition  as  scars  or  dermatitis  depending  on the

predominant disability. The VA examination documented subjective reports of pain with use at surgical sites and plantar warts, and showed objective findings of redness and scaling at the surgical sites and multiple warts at the balls of the feet. Panel members agreed that the pain (surgical and wart) was the predominant disability to support a 10% rating under painful scars, and determined that metatarsalgia or pain at the metatarsal heads most closely approximated the CI’s functional impairment for a 10% rating analogous to 5279 (metatarsalgia unilateral or bilateral). After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral foot condition, coded 5299-5279.

BOARD FINDINGS: In the matter of the left ankle condition, the panel recommends it as a separately unfitting condition rated at 10% and coded 5299-5271 IAW VASRD §4.71a. In the matter of the bilateral foot condition, the panel recommends it as separately unfitting condition, rated at 10% and coded 5299-5279 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Pain	5299-5271	10%	
Bilateral Foot Pain	5299-5279	10%	
	COMBINED	20%	

AR20190013197, XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

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.