RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02456
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E2, Administrative Support, medically separated for “chronic right 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 - 20050929	VARD - 20060724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5099-5003	10%	Chronic Right Foot Pain	5299-5284	10%	20060605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured her right foot while maneuvering the obstacle course at basic training.  The right foot condition required three surgeries that resulted in a right metatarsal phalangeal (MTP) joint fusion and a diagnosis of right-first MTP joint degenerative arthritis.  An orthopedic examination on 8 August 2005, 3 months prior to separation, documented no motion of the fused right-first MTP joint, but right ankle and subtalar range of motion was normal.  

The 20 September 2005 MEB NARSUM examination noted CI complaints of right foot pain which increased with prolonged standing and walking.  Physical examination revealed an antalgic gait and the inability to perform heel or toe walking due to increased pain.  There was moderate tenderness about the surgical scar over the right-first MTP joint which demonstrated no motion.  A permanent profile issued the same day allowed the CI to walk, bike or swim at her own pace, and carry 20 pounds, but limited standing to no more than 15 minutes.  

At the 5 June 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported right foot and leg pain with weight bearing, but little or no pain with rest.  The examiner noted a normal gait and painful manipulation of the right foot.  Ankle dorsiflexion was to 4 degrees (normal 20) and plantar flexion to 60 degrees (normal 45), without painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight, constant pain.  The VA also rated the right foot condition 10%, but analogously coded 5299-5284 (foot injury, other), based on the C&P examination, citing moderate symptoms.  Panel members agreed that because there was no right-first MTP joint motion due to the fusion surgery, a rating based on limited motion was inappropriate.  The criterion for code 5003, which was utilized by the PEB, did not support a rating greater than 10%.  When considering a higher rating under code 5284, the panel noted that the CI experienced increased foot pain after prolonged standing or walking, but was able to perform her administrative duties, and thus adjudged that a 10% rating for moderate impairment was appropriate.  The panel concluded there were no other reasonable coding options for 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 right foot condition.

BOARD FINDINGS:  In the matter of the right 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 20170311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

	PD-2017-02456

AR20200000625, XXXXXXXXXXXXXXXXXXXX 

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