RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01844
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic pain of the left foot” with a disability rating of 0%.

CI CONTENTION:  Not all conditions were considered.  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 - 20050728	VARD - 20060112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain of the Left Foot 	5010	0%	S/P Left Foot Lisfranc Fracture	5284	10%	20050718	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Pain of the Left Foot.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgery on 5 October 2003 for a Lisfranc fracture.  The hardware was removed 6 months later and post-surgical X-rays documented a proximal fibular fracture that was treated non-operatively and healed without sequelae.  The 18 March 2005 MEB NARSUM examination, 8 months prior to separation, noted constant left foot pain exacerbated by walking on uneven surfaces, cold weather, running, ruck marching and sit-ups.  Physical examination showed pain with toe raises and mid-foot tenderness.

At the 18 July 2005 VA Compensation and Pension (C&P) evaluation, 4 months before separation, the CI reported pain and swelling with standing and walking.  Physical examination showed a normal gait and posture, but there was painful motion and tenderness.  Ankle range of motion (ROM) was dorsiflexion of 20 degrees (normal) and plantarflexion of 45 degrees (normal), without painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 0%, coded 5010 (arthritis due to trauma).  The VA rated the left foot condition 10%, coded 5284, (foot injuries, other), based on the C&P examination, citing moderate foot symptoms.  The panel agreed that VASRD code 5279 (metatarsalgia) best-analogously captured the CI’s clinical symptoms at separation, which supports a maximum rating of 10%.  There was no evidence of acquired flatfoot or claw foot to rate under the respective codes (5276, 5278).  There was no evidence of hammertoe (5282) or fracture with malunion or nonunion of a tarsal or metatarsal bone to rate under code 5283.  The panel judged that the severity of the CI’s condition did not rise above the “moderate” level to render a rating higher than 10% under code 5284.  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 left foot condition, coded 5299-5279.

BOARD FINDINGS:  In the matter of the left foot condition, the panel unanimously recommends a disability rating of 10%, 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 as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain of the Left Foot 	5299-5279	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170317, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180005427, 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