RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-04011 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090528

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “bilateral foot pain” and “bilateral inguinal pain,” rated 20% (10% each) and 0% respectively, with a combined disability rating of 20%.

CI CONTENTION: Review requested of the inguinal hernia as well as 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 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 - 20090402	VARD - 20091023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries, Other. Bilateral Foot Pain…	5284	10% +
10%	Sesamoid Fracture Left Foot	5299-5284	0%	20090803	
			Sesamoid Fracture Right Foot	5299-5284	0%	20090803	
Bilateral Inguinal Pain	8799-8730	0%	Bilateral Inguinal Hernia Repair	7338	0%	20090803	
Abnormal Liver Function	Not Unfitting	No VA Placement	
Helicobacter Pylori Gastritis	Not Unfitting	No VA Placement	
Obstructive Sleep Apnea	Not Unfitting	Obstructive Sleep Apnea	6847	50%	20090803	
Gout	Not Unfitting	Gout Right Foot	5017	NSC	20090803	

Bilateral Knee Arthritis	
Not Unfitting	Patellofemoral Pain Syndrome, Left Knee	5299-5260	0%	20090803	
		Patellofemoral Pain Syndrome, Right Knee	5299-5260	0%	20090803	
Acid Reflux	Not Unfitting	Gastroesophageal Reflux Disease	7399-7346	0%	20090803	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Bilateral Foot Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI fractured his right sesamoid in 2005 and had surgery in October 2006 to remove it.       In 2008, he injured his left sesamoid and an X-ray was consistent with a sesamoid

fracture with nonunion. However, no further surgery was recommended for foot pain. During the 12 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bilateral foot pain, and the examiner noted painful feet with normal, asymptomatic arches. The 18 February 2009 MEB NARSUM examination, 3 months before separation, noted bilateral foot pain. Physical examination showed ankle dorsiflexion to 20 degrees (normal) and plantar flexion to 40 degrees (normal 45) bilaterally, and no additional loss following repetition with application of DeLuca criteria.

At the 3 August 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported bilateral foot pain with flares. Physical examination showed a normal posture, weight bearing, and gait. Although there was plantar tenderness over the first metatarsophalangeal joints bilaterally, the arches were normal with no tenderness, deformity, swelling or erythema.  Bilateral ankle ROM was full and painless.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral foot condition 10% for the left foot and 10% for the right foot, coded 5284 (foot injuries, other), citing moderate injury of each foot. The VA rated the left foot and right foot conditions 0% each, analogously coded 5284, based on the C&P examination, citing a noncompensable evaluation in the absence of moderate symptoms for each foot. Panel members agreed that there were no examinations in evidence which supported the next higher “moderately severe” foot injury rating for either foot. 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 either the left foot or right foot conditions.

Bilateral Inguinal Pain. According to the STR and MEB NARSUM, the CI underwent double inguinal hernia surgery in May 2007 and subsequently developed daily bilateral inguinal pain without associated gastrointestinal or genitourinary symptoms. Nerve blocks and physical therapy did not resolve the pain. During the MEB examination, he reported bilateral groin pain, and the examiner noted inguinal and suprapubic pain with no hernias. The MEB NARSUM examination recorded complaints of chronic bilateral inguinal pain, rated at 4-5/10, which increased to 8/10 with activity. Physical examination appeared to be from the MEB, with no new findings. At the C&P examination, he reported constant groin pain with flare-ups exacerbated by prolonged walking. The examiner documented normal gait, squatting, and heel-toe walking. Groin examination showed no hernia recurrence, but there was moderate tenderness with testing.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral inguinal condition 0%, analogously coded 8730 (neuralgia, ilio-inguinal nerve), citing pain increased with activity and no abdominal tenderness or hernia. The VA also rated the bilateral inguinal condition 0%, but coded 7338 (hernia, inguinal), based on the C&P examination, citing no evidence showing objective symptoms required for a higher evaluation, and a non-compensable evaluation for bilateral remediable hernias, or hernias that are small, reducible, or without true hernia protrusion. Panel members noted that VASRD §4.124 (neuralgia, cranial or peripheral) specifies that neuralgia is to be rated with a maximum equal to moderate incomplete paralysis, which is 0% under code 8730. Additionally, there was no recurrent hernia on either side for any higher alternate rating under code 7338. 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 bilateral inguinal condition.

Contended PEB Conditions: Abnormal Liver Function, Helicobacter Pylori Gastritis, Obstructive Sleep Apnea, Gout, Bilateral Knee Arthritis and Acid Reflux. 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 or implicated in the commander’s statement, and none failed

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 determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the bilateral inguinal condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended abnormal liver function, helicobacter pylori gastritis, obstructive sleep apnea, gout, bilateral knee arthritis and acid reflux 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. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20200000634, 

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.

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