RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03160
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “chronic right foot pain” with a disability rating of 20%.  

CI CONTENTION:  The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060616	VARD - 20070530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5284	20%	S/P ORIF of Right Foot 	5284	20%	20061228	
Right Conductive Hearing Loss	Not Unfitting	Tinnitus	6260	10%	20061214	
Major Depressive Disorder	Not Unfitting	Major Depressive Disorder	9434	50%	20061218	
Chronic Intermittent Low Back Pain	Not Unfitting	Mild Loss of Lumbar Lordosis	5237	10%	20061205	
Mild Hypertriglyceridemia	Not Unfitting	No VA Placement	
History of Tension Headaches	Not Unfitting	Recurrent Headaches	8100	10%	20061228	
Decreased Visual Acuity	Not Unfitting	Right Eye Condition	6079	NSC	20061205	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained multiple tarsal and metatarsal fractures, the worst of which was the second metatarsal of the right foot after a motor vehicle accident in March 2005.  He underwent surgical repair on 9 June 2005 of the right foot with fusing (arthrodesis) of the first, second and third metatarsal cuneiform joints.  Thereafter, he underwent casting and physical therapy.  Postoperative imaging studies showed proper anatomical placement with retained metallic screws with a marked deformity over the proximal second and third metatarsals believed to be due to old healed fractures.  In January 2006, 7 months postoperatively, the CI complained of pain with prolonged walking and carrying weight.  

An orthopedic MEB consultation, dated 26 January 2006, 6 months prior to separation, noted complaints of pain and stiffness across the top of his right foot.  Examination showed well-healed surgical scars.  There was a moderate decrease in the medial longitudinal arch of the foot, but no significant calcaneal valgus deformity.  There was mild swelling over the dorsal mid foot area with mild protrusion of the first metatarsocuneiform.  Flexion of the digits on the metatarsals was within normal limits in both dorsiflexion and plantar flexion.  Movement of the metatarsal joints was significantly limited with pain on movement of the right foot.  Gait was antalgic on the right and there was a mild to moderate pronated right foot.  

At a podiatry clinic visit on 2 May 2006, 3 months prior to separation, the examiner noted very limited motion of the right foot metatarsophalangeal joint, mild edema, tenderness of the right mid foot and right-sided antalgic gait.  The 23 May 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain and stiffness of the right foot.  Physical examination showed right foot metatarsal pain and hypoesthesia (decreased sensation) of the anterior right ankle.  Range of motion (ROM) testing of the right ankle showed dorsiflexion of 8 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  

At the 28 December 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported chronic pain of the right foot.  After separation, he worked and serviced military vehicles.  Physical examination showed a limp of the right lower extremity.  He had two tender scars on the dorsum of the right foot and a scar on the medial malleolus.  The right ankle had no edema, but there was decreased sensation to light touch on the foot.  The ROM study showed 0 degrees of dorsiflexion and 25 degrees of plantar flexion with pain.  X-rays showed post-surgical changes of the right foot with multiple surgical screws in the first, second and third metatarsals and cuneiform bones.  There was no evidence of a periprosthetic lesion or lucency, and no evidence of fracture.

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), citing moderately severe foot injury.  The VA also rated the right foot condition 20%, coded 5284, based on the C&P examination, citing limited ROM with pain.  A 30% rating under code 5284 requires the foot injury to be severe; however, at the time of separation and thereafter, the CI was able to ambulate, albeit with pain and a limp, and had retained screws and healing of the fractures.  Therefore, the panel felt there was insufficient evidence to support a 30% rating at the time of separation.  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.  

Contended PEB Conditions:  Right Conductive Hearing Loss, Major Depressive Disorder, Chronic Intermittent Low Back Pain, Mild Hypertriglyceridemia, Tension Headaches and Decreased Visual Acuity.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions carried significant profile restrictions.  Although back pain and headaches were implicated in the commander’s statement, none of the conditions were judged by the MEB to fail retention standards.  The panel noted that hypertriglyceridemia is an abnormal lab finding and not a physical disability.  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 determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hearing loss, major depressive disorder, back pain, hypertriglyceridemia, tension headaches and decreased visual acuity, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:  

[AR NUMBER], 

Dear XXXXXXXXXXXXXXXXX:

	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.

Enclosure