RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02572
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3 , Pharmacy Specialist, medically separated for “left foot metatarsalgia” and “left foot paresthesias,” rated 10% each, with a combined disability rating of 20%.  

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 - 20081208	VARD - 20090302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Metatarsalgia, Left Foot	5279	10%	Metatarsalgia, Left Foot 	5279	10%	20080930	
Paresthesia, Left Foot	8621	10%	Paresthesia, Left Foot	8621	10%	20080930	
Anxiety Disorder/ Major Depressive Disorder (MDD)	Not Unfitting	Posttraumatic Stress Disorder, MDD 	9411	50%	20080906	
Gastroenteritis	Not Unfitting	Irritable Bowel Syndrome 	7319	10%	20081001	
Sinusitis	Not Unfitting	Sinusitis	6510	10%	20081001	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY: 

Left Foot Metatarsalgia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgical correction in May 2007 with third metatarsal shortening and fourth metatarsal osteotomy.  The surgery was complicated by an infection and her pain continued to progress despite further treatment with steroid injections and NSAIDs.  

At the 30 September 2008 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported left foot pain and altered sensation on the outer aspect of the left foot.  The physical examination (PE) revealed a painful surgical scar and hypopigmentation of the surrounding skin.  The third and fourth left metatarsals lacked active motion, were severely tender and the CI walked with a pronounced limp.   

The 27 October 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of left foot pain and episodic swelling.  She endorsed difficultly with prolonged standing or walking.  The PE findings parroted the C&P examination above.  She was diagnosed with left foot metatarsalgia, left foot paresthesia, secondary to foot surgery, and left foot dorsum pigmentation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot metatarsalgia 10%, analogously coded 5299-5279 (metatarsalgia, anterior (Morton’s disease)).  The VA also rated the left foot metatarsalgia 10% based on the C&P examination.  

Panel members agreed the historical evidence of surgically treated metatarsal bones complicated with post-operative infection and persistent pain was best supported by the PEB’s chosen code of 5279 and the maximum rating of 10% was appropriate in this case.  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’s adjudication for the left foot metatarsalgia.

Left Foot Paresthesia.  According to the STR and MEB NARSUM, the CI’s left foot paresthesia was asymptomatic until after she underwent left foot surgery.  The 1 October 2008 VA C&P examination, 5 months prior to separation, noted normal extremities without paresthesia.  The PE was normal with the exception of an abnormal gait.  The NARSUM showed no additional or new physical findings.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the left foot paresthesias 10%, coded 8621 (neuritis: external popliteal nerve (common peroneal)) citing incomplete (mild) paralysis of foot movements.  Panel members first agreed that the alteration of sensation being on the lateral aspect of the left foot was anatomically appropriate to the distal aspect of the common peroneal nerve.  The ratings under 8521 for incomplete paralysis include 10% for mild impairment and 20% for moderate impairment.  The VASRD §4.124a (schedule of ratings for neurologic conditions) states “when the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree.” The panel considered the evidence for a higher rating than the 10% adjudicated by the PEB.  Members deliberated and concluded that having no motor deficits and only decreased sensation to a single side of the foot met the “wholly sensory” criteria.  Although the STR revealed evidence of severe tenderness on the left foot as well as an abnormal gait, members concluded that such findings were overwhelmingly attributed to the metatarsalgia and minimally, if at all, attributed to nerve involvement.  Therefore, when strictly looked at as to the amount of abnormal neurologic findings, the minimal affected area on the outside of the foot would be accurately rated no greater than ‘mild’ impairment.  After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change to the PEB’s 10% adjudication for the left foot paresthesia.         

Contended PEB Conditions:  Anxiety Disorder/MDD, Gastroenteritis and Sinusitis.  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, implicated in the commander’s statement 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 determinations for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left foot metatarsalgia and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left foot paresthesia and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder/MDD, gastroenteritis, and sinusitis, the panel recommends no change from the PEB’s determination 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190009128, 

Dear XXXXXXXXXXXXXXX:

	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.