RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04800
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “right foot pain” 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 - 20050906	VARD- 20060509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5099-5003	0%	Right Tarsal Tunnel Syndrome	8521-5003	10%	20050126	
Migraine Headache 	Not Unfitting	Chronic Migraine Headaches	8100	30%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Right Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right foot condition began insidiously in 2003 without trauma or injury.  The 18 February 2005 MEB NARSUM examination, 11 months prior to separation, noted complaints of right foot pain exacerbated by weight bearing and ambulation.  The pain was quite debilitating and prevented running, carrying heavy objects or soldiering activities.  Physical examination showed decreased pin prick sensation over the medial aspect of her right foot, sole and medial aspect of the leg up to about the mid-shin.  Gait was normal.  At the 8 June 2005, primary care examination, 6 months prior to separation, the CI reported right foot numbness and pain.  Physical examination showed a stable right ankle with full range of motion (ROM) without pain.  

At the 26 October 2005 VA Compensation and Pension (C&P) general examination, 3 months after separation, the CI reported right foot pain, weakness, stiffness, swelling and fatigue while standing.  The condition did not result in any time lost from work.  Physical examination revealed a normal gait and no signs of abnormal weight bearing.  The right ankle ROM study showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 25 degrees (normal 45) both with painful motion.  

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 foot condition 10%, dual coded 8521-5003 (paralysis of the external popliteal nerve-degenerative arthritis), based on the C&P general examination citing mild disability affecting the right foot and ankle.  

The panel noted that the CI’s symptom’s occurred while weight bearing.  The panel majority concluded there was moderate right ankle limitation of dorsiflexion and plantar flexion that supported a rating under the VASRD diagnostic code for ankle limitation of motion (5271) based on the C&P examination.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the right foot condition, coded 5271.  

Contended PEB Condition:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated by the commander’s statement as preventing the CI from performing her military duties, or judged to fail retention standards.  The NARSUM specifically stated that the CI’s chronic migraine headaches had “improved with medical treatment and [did] not interfere with the reasonable performance of her assigned duties.”  Therefore, there was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right foot condition, the panel majority recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommends no change, but does not elect to submit a minority opinion.  In the matter of the contended migraine headaches, the panel agrees it cannot recommend it for additional disability rating.  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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Foot Pain	5271	10%	

The following documentary evidence was considered:

[AR NUMBER], 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 tor 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 tiled with your Physical Evaluation Board records. I regret that the tacts 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 tiling suit in a court of appropriate jurisdiction.

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

Enclosure