RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02291
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090807

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Multichannel Radio Transmitter Maintainer Operator, medically separated for “foot injuries, other, referred to as chronic left foot pain” with a disability rating of 10%.

CI CONTENTION:	“Missed  some  physical  conditions  that  the  Veteran Affairs found.”	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 - 20090723	VARD - 20100708	
Condition	Code	Rating	Condition	Code	Rating	Exam	

…Chronic Left Foot Pain	
5284	
10%	Residuals, Status Post Surgery, Chronic Left Ankle Sprain	5399-5322	30%	20070712	
			Bunion, Left Foot, With Hallux Valgus and Degenerative Joint Disease	5280	10%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Chronic Left Foot Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left foot condition began in 2002 while on active duty service with the United States Marine Corps (USMC), and he later underwent surgery by a VA orthopedic surgeon on 18 December 2006.     No operative reports were available, but an osteotomy of the

left calcaneus with internal fixation, exploration of the left Achilles tendon and a bunionectomy of the left great toe were performed. A 25 July 2007 VA Rating Decision increased a 10% rating for residuals of ankle sprain to 30% based on a VA Compensation and Pension (C&P) examination dated 12 July 2007, which showed ankle dorsiflexion of 6 degrees (normal 20), painful motion, ankle weakness graded 4/5, and atrophy of the calf muscles. He was subsequently released without restrictions by the operative surgeon.   The CI underwent an additional surgery on       21 March 2008 to remove a ganglion cyst which had developed on the bottom of his foot.

At the 30 September 2008 military enlistment physical examination, the CI reported the surgeries and that he had been discharged from the USMC due to his foot. On physical examination, the “normal” box next to lower extremities and feet was checked, and mild asymptomatic pes planus was noted. Although the lower extremities and feet were determined to be disqualifying, with a permanent L3 profile, the CI was given a waiver and then entered the United States Army and began the Warrior Transition Course on 4 November 2008. Due to training, the CI’s left foot pain worsened, and he was seen at sick call. A left foot X-ray revealed intact surgical fixation screws, and no acute fracture, dislocation, subluxation or periosteal reaction. He was placed on a permanent L2 profile, but during a training exercise stepped in a hole exacerbating his foot pain. Repeat X-rays showed no change. Conservative treatment rather than surgical intervention was recommended, and the pain improved, but did not resolve.

During the 24 February 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination of the left foot/ankle showed decreased range of motion (ROM) and strength. At a podiatry examination on 8 April 2009, 4 months before separation, the CI reported he was not wearing his ankle/foot brace because he was relatively pain-free when wearing soft shoes. Physical examination showed a palpable plantar fibroma that was decreased in size, and no tenderness along the surgical incisions. The CI was able to stand on the left foot and perform a single toe raise as well as squat below 90 degrees without assistance. Ankle ROM showed minimally decreased dorsiflexion, without pain or crepitus, and foot strength graded 5/5. At a podiatry follow-up visit on 29 April 2009, 3 months prior to separation, the CI reported greatly diminished left foot pain and the ability to perform tasks with minimal pain. He was not using a brace, and the provider noted improved ROM with minimal tenderness of the plantar fibroma, no swelling, and normal neurovascular findings.

The 17 July 2009 MEB NARSUM examination, 1 month prior to separation, noted complaints of constant left foot pain with flare-ups due to weight bearing activities. These flare-ups occurred daily and lasted 1-2 hours. Physical examination showed a normal gait and well-healed surgical incisions. The left ankle ROM, following repetition, showed dorsiflexion of 15 degrees and plantar flexion of 40 degrees (normal 45). The examiner documented tenderness of the Achilles tendon and heel, as well as the top of the foot over the first metatarsal, but no swelling or atrophy of the lower extremity.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot condition 10%, coded 5284 (foot injuries, other), citing moderate injury. The VA rated left foot bunion with hallux valgus and degenerative joint disease 10%, coded 5280 (hallux valgus) based on the STR and the October 2007 C&P examination. The VA also rated chronic left ankle sprain residuals 30%, analogously coded 5399-5322 (group XXII function), citing severe muscle disability, based on the July 2007 C&P examination. Panel members agreed that  a 10% rating was supported under code 5284, but a 20% for a “moderately severe” impairment was not supported as podiatry examinations proximate to separation noted minimal pain in soft shoes, normal strength, and no use of an ankle brace. While the MEB NARSUM examination documented foot tenderness, there was no swelling or weakness, and the CI had a normal gait and near normal ankle ROM. The panel noted that a 10% rating was also supported under code 5280 or analogously coded to 5279 (metatarsalgia), but neither code provided a ratings benefit. There was no limitation of dorsiflexion or plantar flexion to support a rating under code 5271

(ankle, limited motion of), and all alternative VASRD ankle and foot codes were less applicable and/or not advantageous to rating. 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 20170228, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190009443, 

Dear XXXXXXXXXXXXXX:		

	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