RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02931
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20071112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Heavy Construction Equipment Operator, medically separated for “crush injury right foot” with a disability rating of 20%.  

CI CONTENTION:  “Because the conditions are still existing and are worse now than they were then.  I still have problems with my toes.  I am looking at having another surgery now.”  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 - 20070703	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crush Injury Right Foot	5284	20%	No VA Examination in Evidence Proximate to Separation	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Right Foot Crush Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began on 25 August 2006 after a heavy oil pan weighing 300 pounds fell on his foot.  After an initial operation which included pinning all of the toes of the right foot and suturing soft tissue wounds, he was aeromedically evacuated to home station with several stops along the way.  On 8 September 2006, the middle toe was amputated due to gangrenous changes leaving the third metatarsal intact.  The CI continued to have foot pain with weight bearing and additional surgery was not indicated.  Further therapy did not result in the CI being able to return to unrestricted duty.  
At the 27 February 2006 MEB podiatry evaluation, 8 months prior to separation, the examiner noted the third right toe amputation at the metatarsophalangeal joint and tenderness to the forefoot (plantar greater than dorsal surfaces).  The podiatrist also documented that the eschar (dead tissue), which had developed on the distal plantar aspect of the fourth toe, had resolved without the need for a partial amputation as previously anticipated.  

The 1 May 2007 MEB NARSUM examination, 6 months prior to separation, noted the CI was able to perform activities of daily living, including driving, and that he was working in his military specialty “for the most part” and could do all of his job-specific tasks.  He was unable to run, ruck or march due to foot pain.  Physical examination showed the third toe was absent with a well- healed surgical scar.  The fourth digit was rotated medially with a scab at the tip of the toe, and the examiner recorded decreased range of motion (ROM) of the right toes.  At the 8 May 2007 MEB physical therapy (PT) ROM evaluation, the examiner noted flexion contractures of the fourth and fifth toes.  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 right foot condition 20%, coded 5284 (foot injuries, other–moderately severe), citing the crush injury to the foot and amputation with continued pain and preserved digit ROM.  
Members agreed that a 20% rating, but no more, was justified for the severity the injuries to the foot under code 5284.  There was no evidence of acquired flatfoot (5276), claw foot (5278) or fracture of the tarsal or metatarsal with malunion or nonunion (5283) to validate a rating under the respective codes.  Although there was evidence of hammer toe in two of the toes of the right foot, the maximum rating (5282) is only 10% if all toes of the foot are involved.  The panel also considered codes for toe amputations, but none were advantageous to the CI.  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 foot condition.  

BOARD FINDINGS:  In the matter of the right foot crush injury 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 20170405, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006183, 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.

Sincerely,					      
Enclosure