RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-04182
BRANCH OF SERVICE:  army	SEPARATION DATE:  20060923

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 “right foot pain” with a disability rating of 10%.   

CI CONTENTION:  Review the rating for the right foot.  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 - 20060731	VARD - 20070427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5279	10%	Tenosynovitis, Right Foot	5010-8284	10%	20070306	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured the fifth metatarsal bone in the right foot in January 2004 and underwent an open reduction internal fixation, with removal of the implanted surgical hardware 3 months later.  Post-surgical radiographic studies in May 2006 revealed a healed fracture of the fifth metatarsal bone.  At the 2 June 2006 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint was “right foot pain.”  The physical examination (PE) revealed a normal gait with localized tenderness.  Right ankle and foot range of motion was normal, but there was pain with flexion and extension of the right fourth and fifth metatarsal bones.

At the 6 March 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant right foot pain aggravated by physical activity.  The PE revealed no tenderness, weakness, edema, atrophy or disturbed circulation of the right foot.  Specifically, Morton’s metatarsalgia was not present.  The examiner also noted that although the CI required foot supports, he did not have any limitations with standing or walking.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5279 (metatarsalgia), citing tenderness.  The VA  also rated the right foot condition 10%, but dual coded 5010-5284 (traumatic arthritis due to foot injury, other), based on the C&P examination, citing foot pain.  Panel members first agreed the mechanism of injury, surgical intervention and subsequent continuation of localized pain clearly equated to a chronic condition of right foot metatarsalgia, which justified the PEB’s 10% rating under code 5279.  There was also evidence of painful motion near the time of separation, which supported an alternate 10% rating (§4.59).  There were no other VASRD rating options that would yield a higher rating than the PEB’s 10% 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 right foot condition.  

BOARD FINDINGS:  In the matter of the right foot condition 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:

	PD-2017-04182

AR20190012075, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX

	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.

	PD-2017-04182