RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04605
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “right foot pain” with a disability rating of 10%.  

CI CONTENTION:  “I still have pain in my foot with every step causing a limp and an inability to run.”  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 - 20060828	VARD - 20070628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain 	5299-5279	10%	Chronic Sesamoiditis of the Right Foot	5299-5284	10%	20070508	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Foot Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s right foot condition began in October 2003 during a field training exercise.  He did not seek medical treatment at that time and pressed on.  In September 2005 while running sprints, he noted a pop in his great toe with immediate swelling, pain and difficulty with weight bearing.  Surgery would not likely return the CI to active duty military service.        

The 24 July 2006 MEB NARSUM examination, 2 months prior to separation, showed the CI walked with a slightly antalgic gait (ambulated bearing weight on the lateral aspect of the right foot to avoid pain).  There was severe tenderness at the lateral aspect of the plantar surface of the great toe.  There was no edema.  Neurological examination was essentially within normal limits.  The remainder of the physical examination (PE) showed no gross abnormalities.  

At the 9 May 2007 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported chronic plantar foot pain of the great toe.  PE showed a mildly antalgic gait.  There was no crepitus.  Footwear demonstrated diffuse overall wear without specific abnormal wear of the right shoe versus the left shoe.  He was unable to squat or rise on the toes of the right foot secondary to pain.  Neurovascular and dermatological examination was intact.  There was no limitation of motion or incoordination appreciated by the podiatrist.  X-ray impression was chronic sesamoiditis of the right foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5279 (metatarsalgia, anterior, unilateral or bilateral).  The VA also rated the right foot condition 10%, analogously coded 5284, (foot injuries, other), based on the C&P examination.  There were no other codes under VASRD §4.71a which are applicable and favorable in this case, other than consideration of a 20% rating under 5284 for “moderately severe” disability.  Members agreed that metatarsalgia reasonably reflected the clinical features and disability associated with this case and that the functional limitations in evidence rose to the moderate level of foot disability.  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 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:

Exhibit A.  DD Form 294, dated 20170517, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006692, 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