RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02938
BRANCH OF SERVICE:  aRMY	SEPARATION DATE:  20050521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Voice Interceptor, medically separated for “chronic pain, right foot” with a disability rating of 0%.

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 - 20050330	VARD - 20050914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Foot	5099-5003	0%	Status Post Cheilectomy, Right Great Toe with Degenerative Joint Disease	5299-5283	20%	20050809	
Back Pain	Not Unfitting	Osteophytes, Lumbar (L3-L4) Spine	5242	0%	20050809	
Right Hip Pain	Not Unfitting	Right Hip Degenerative Joint Disease	5299-5255	0%	20050809	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began insidiously sometime during basic training.  He was diagnosed with hallux limitus (stiffness of the metatarsophalangeal joint of the big toe).  On 9 July 2004, the CI underwent a left foot cheilectomy (removal of an abnormal bone growth) of the first metatarsal to treat the condition.  Following surgery, he showed good healing clinically and radiographically, but was unable to return to full duty or wear his left military boot due to pain.
The 21 January 2005 MEB NARSUM examination, 4 months prior to separation, showed “full” range of motion (ROM), and a normal gait and station.  Atrophy was absent and motor function intact with a normal foot arch.  The 26 January 2005 MEB physical therapy evaluation revealed limited flexion and extension of the right great toe with painful motion compared to the left.  The CI’s gait was abnormal due to pain.

The 9 August 2005 VA Compensation and Pension (C&P) general evaluation, 3 months after separation, noted complaints of ongoing right great toe pain but no limitations in activities of daily living or use of an assistive device, shoe inserts, braces, or corrective shoes.  Physical examination showed a normal gait and posture.  Right great toe motion was limited and painful.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right big toe condition 20%, analogously coded 5299-5283 (tarsal, or metatarsal bones, malunion, or nonunion), based on the C&P evaluation, citing malunion or nonunion of the tarsal or metatarsal bones with moderately severe symptoms.  Members noted that while the CI had limited and painful motion of the right great toe, the majority of examinations showed a normal gait and posture.  This is consistent with a “moderate” impairment which supports a 10% rating under either code 5283 or 5284 (other foot impairment).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right foot condition, coded 5283.

Contended PEB Conditions:  Back Pain and Right Hip Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement, and both were judged to meet retention standards.  There was no performance-based evidence from the record that any of the contended 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 determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the right foot condition, the panel recommends a disability rating of 10%, coded 5283 IAW VASRD §4.71a.  In the matter of the contended back and right hip pain conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Foot Pain	5283	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170322, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180006188, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure