RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02258
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “chronic right foot pain…” and “chronic right ankle pain…,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  Review requested for all conditions to include 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 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 - 20090717	VARD - 20091019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5279	10%	Residuals, Cyst Removal Right Ankle and Foot with Recurrent
Nodule 	5284	10%	20090922	
Chronic Right Ankle Pain	5099-5003	10%					
Right Shoulder Pain	Not Unfitting	Residuals, Right Shoulder Fracture	5203	10%	20090922	
Right Wrist Pain	Not Unfitting	Right Wrist Condition	5215	NSC	20090922	
Cervicalgia	Not Unfitting	No VA Placement	
GERD	Not Unfitting	Gastroesophageal Reflux Disease	7399-7346	0%	20090922	
Hypertension	Not Unfitting	Hypertension	7101	10%	20090922	
Hyperlipidemia	Not Unfitting	No VA Placement	
Latent Tuberculosis	Not Unfitting	Tuberculosis 	6799-6731	NSC	20090922	
Obesity		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right foot pain condition began in October 2006.  In May 2007, he had right foot surgery to remove a plantar cyst; however the tumor returned, this time involving the peroneal nerve causing constant pain with walking.  Despite occupational and physical therapies, he started to have numbness in the bottom of the foot.  

During the 29 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported foot problems.  Physical examination revealed a tender mass in the mid aspect of the plantar fascia of the right foot.  

The 24 June 2009 MEB NARSUM examination, one month prior to separation, noted complaints of 6-7/10 pain on the bottom of his right foot and a "pins and needles" sensation from first digit to the third digit, across the top of the foot, to the ankle.  Physical examination showed tenderness over the dorsal scar, and tender to pressure over the nodule on plantar foot.  The nodule was solid and deep, and did not move with the tendon.  There was a flat arch on the right which was more pronounced due to the nodule.  Sensory nerve testing was intact to pinpoint, though pressure on the dorsum of the foot from the ankle to third toe to the first toe was blunted with worsening of the "pins and needles" sensation.  

At the 22 September 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continuous right foot 4-7/10 pain.  Physical examination showed the right foot had slight pain in the metatarsal bones that radiated up into the ankle.  There was a nodule on the plantar surface of the right foot.  Neurologically the CI was appropriately responsive to all sensory stimuli.  His gait was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5279 (analogous to metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral), citing pain.  The VA rated the combined right ankle and foot condition 10%, coded 5284 (foot injuries, other), based on the C&P examination, citing a foot injury with moderate symptoms.  

The panel noted there was evidence of metatarsalgia, anterior (Morton’s disease) to support a 10% rating (5279).  There was no limitation of dorsiflexion or plantar flexion of either foot that supported a higher rating under the VASRD diagnostic code for limitation of motion (5271).  There was no bilateral foot weakness which supported a rating under the diagnostic codes for weak foot (5277).  Nor was there evidence of claw foot (5278), acquired flatfoot (5276) tarsal or metatarsal bone malunion or nonunion (5283).  There was evidence of other foot injuries (5284) to support a moderately severe 20% rating under their respective diagnostic codes (big toe).  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 right foot condition.  

Chronic Right Ankle Pain.  According to the STR and MEB narrative summary (NARSUM), the CI’s right foot pain condition began in October 2006.  In May 2007 he had surgery of the right anterior ankle to remove a cyst.  A June 2008 MRI showed an apparent nerve entrapment at the anterior right ankle (deep peroneal).  

The 24 June 2009 MEB NARSUM examination, one month prior to separation, noted complaints of 6-7/10 pain on the bottom of his right foot and a "pins and needles" sensation from 1st digit to the 3rd digit, across the top of the foot, to the ankle.  Physical examination showed grossly normal flexion and extension of the ankle, with diminished lateral and medial flexion.  Sensory nerve testing was intact to pinpoint, though pressure on the dorsum of foot from the ankle to third toe to the first toe was blunted with worsening of "pins and needles" sensation.  

At the 30 June 2009 physical therapy evaluation, one month before separation, the CI reported constant 7/10 right ankle pain.  Physical examination showed the right ankle range of motion (ROM) dorsiflexion as 0 degrees (normal 20) and plantar flexion as 35 degrees (normal 45) with pain at the end range in all directions.  

At the 22 September 2009 VA C&P examination, 2 months after separation, the CI reported continuous right ankle 4-7/10 pain and that it felt "like it was broke.”  Physical examination showed no pain with palpation of the right ankle.  Right ankle dorsiflexion was 10 degrees and plantar flexion was 30 degrees.  There was pain and stiffness in the right ankle with ROM but no loss of ROM with repetitive movements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing loss of motion.  The VA rated the combined right ankle and foot condition 10%, coded 5284 (foot injuries, other), based on the C&P examination, citing a foot injury with moderate symptoms.  

The panel agreed that the NARSUM orthopedic and C&P examinations were consistent with the “moderate” limitation of motion required for the minimum 10% rating under code 5271.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher 20% rating.  The panel also considered whether rating under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however all panel members agreed that the “severe” level (30%) was not supported.  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 for the right ankle condition.  

Contended PEB Conditions:  Right Shoulder Pain, Right Wrist Pain, Cervicalgia, GERD, Hypertension, Hyperlipidemia, Latent Tuberculosis, and Obesity.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, and only the right shoulder was implicated in the commander’s statement.  The NARSUM noted that CI’s right shoulder caused periodic pain but he was able to do push-ups, had no restrictions with overhead activity or with the Army physical fitness test push-ups.  Therefore, none of the conditions were judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right shoulder pain, right wrist pain, cervicalgia, GERD, hypertension, hyperlipidemia, latent tuberculosis, and obesity conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015074, 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.

A copy of this decision has been provided to the counsel you listed on your application; XXXXXXXXXXXX   VAMC, Attn:XXXXXXXXXXX, 1 Jefferson Barracks Drive, Building 1, Room C 110, St Louis, MO 63125.

Sincerely,					       

Enclosure