RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02834 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aircraft Firefighting and Rescue Specialist, medically separated for “left foot pain” with a disability rating of 10%.

CI CONTENTION: In addition to the left foot condition, the CI requested review of his back condition.  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 - 20060224	VARD - 20070516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Pain	5299-5283	10%	Left Foot Sprain	5284	10%	20070209	
Lumbar Back Pain	Cat III	Degenerative Disc Disease, Lumbar Spine	5243	0%	20070209	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Foot Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced an onset of persistent left foot pain after an injury during basic training in April 2004. A stress fracture was suspected, but serial X-rays and a bone scan were normal, but an MRI demonstrated only nonspecific findings (bursa fluid around the first metatarsal) and an electrodiagnostic study was suggestive of a mild neuropathy (peroneal nerve) but could not exclude an L5 radiculopathy. Multiple neurological examinations of the left lower extremity (LLE) were normal (motor, sensory, reflexes). No conclusive etiology for the left foot pain was identified. There was ample STR documentation of a normal gait, normal ankle and sub- talar (foot) range of motion (ROM), and the absence of any VASRD-ratable foot findings. The only consistent finding was tenderness along the first metatarsal. The 31 January 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of nonspecific left foot pain exacerbated by walking or running. The physical examination recorded normal ankle and foot ROM and normal LLE neurological findings.

The 9 February 2007 VA Compensation and Pension (C&P) examination, 9 months after separation, documented that the CI was “asymptomatic unless standing” with transient pain flares to 7/10 triggered by prolonged standing. The examiner noted aggravation with running and walking over a quarter-mile, but opined that there was no occupational impairment (documenting full time employment as service advisor for a car dealership). The VA physical examination recorded normal gait, LLE neurological findings and ankle ROM without pain. There were no VASRD-ratable foot findings or VASRD-specified foot conditions.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot condition 10%, analogously coded 5299-5283 (tarsal, or metatarsal bones, malunion of, or nonunion of). The VA also rated the left foot condition 10%, coded 5284 (foot injuries, other), based on the C&P examination, citing “moderate” disability. The panel noted that codes 5283 and 5284 have equivalent rating criteria, each conferring a 20% rating for “moderately severe” and 30% for “severe” disability. Members agreed that the functional impairment in evidence at separation was most reasonably characterized as moderate, thus no higher rating was supported under codes 5283 or 5284. The panel considered other VASRD foot, ankle and analogous codes, but all were less applicable and/or not advantageous 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 left foot condition.

Contended PEB Condition: Lumbar Back Pain with Left L5 Radiculopathy. A possible radicular component overlapped the left foot condition as addressed above, and there was no subjective or objective functional deficit proximal to the foot. There was no STR evidence for significant impairment due to the back pain. Both limited duty (LIMDU) boards were for left foot pain, although the final one attributed it to lumbar radiculopathy. The commander’s non-medical assessment implicated only left foot pain and also attributed it to the radiculopathy. Both the NARSUM and post-separation C&P documented normal thoracolumbar ROM without any significant findings (no painful motion and 0% rating by VA). The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. Any separate functional impairment from the possible left L5 radiculopathy was subsumed in the primary unfitting rating for the left foot, consistent with VASRD §4.14 (avoidance of pyramiding). There was no performance-based evidence from the record that the back pain 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the left foot condition (subsuming the left lumbar radiculopathy as above) and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended back condition, the panel recommends no change from the PEB determination as not unfitting. Therefore, the panel recommends there be 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

DEPAR™ENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO :
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 29 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.