RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02162
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Motor Transport Operator, medically separated for “chronic pain left foot” 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’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 - 20070713	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Foot	5099-5003	10%	Hallux Valgus, Left Foot with Sinus Tarsitis	5280	10%	20070806	
			Bilateral Pes Planus	5276	10%	20070806	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Foot Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left foot bunionectomy and tendo-Achilles lengthening in December 2004.  He began to experience post-surgical pain in the sinus tarsi of the left foot.  Conservative treatment failed to resolve his pain.  The 22 June 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued left foot pain.  He was unable to run, march or jump but could carry up to 20 pounds without exacerbation.  Sleep was affected if he did not take his medication (Tramadol).  Physical examination showed normal angle and basic gait.  There was slight antalgia (response to pain or imbalance) in the left lower extremity.  Muscle strength was normal in the distal lower extremities and range of motion (ROM) was normal in the ankle and foot joints.  The first metatarsophalangeal joint (MTJ) was painful with forced dorsiflexion.  ROM of the left subtalar joint produced pain.  There was tenderness at the sinus tarsi (opening between ankle and heel bone) and Achilles tendon of the left foot.  There were no neurovascular findings.

At the 6 August 2007 VA Compensation and Pension (C&P) examination, 6 weeks before separation, the CI reported intermittent pain in the left foot MTJ which could occur spontaneously, but due to bilateral pes planus it was difficult to differentiate.  He reported tenderness in the area of the scar from the left Achilles tendon surgery.  He worked full-time and was able to perform activities of daily living.  Daily pain medications included Tramadol and Tylenol.  Physical examination showed a normal gait and posture without the use of ambulatory aides.  Left ankle dorsiflexion was 15 degrees (normal 20) and plantar flexion was 35 degrees (normal 45) with pain at the extremes.  There was bilateral hallux valgus with 15 degrees lateral deformity but no dorsiflexion.  Toes moved normally with no malalignment of the feet or Achilles tendon noted.  Sensory and motor functions were intact.  Several bilateral foot conditions as well as left foot sinus tarsus and a left first MTJ condition as a residual of bunionectomy were noted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the left foot condition 10%, coded 5280 (hallux valgus, unilateral), based on the C&P examination, citing resection of the metatarsal head.  The VA also rated pes planus 10%, coded 5276, based on findings in the STR and C&P examination.

The panel agreed there was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was sufficient evidence of painful motion causing functional loss to support a 10% rating (IAW VASRD §4.59, §4.40 and §4.45).  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not approximate “moderately severe” to support the next higher 20% rating under this code.  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 adjudication for the left foot condition.

BOARD FINDINGS:  In the matter of the left foot condition 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 20170317, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015053, 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