RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05018
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Armor Crewman, medically separated for “tarsal tunnel syndrome and neuroma, right foot” with a disability rating of 10%. 

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 - 20060706	VARD - 20070315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tarsal Tunnel Syndrome and Neuroma, Right Foot	8725	10%	Residuals, Status Post (S/P) Tarsal Tunnel Release, Right Ankle with Metatarsalgia	5020-8725	10%	20061023	
Left Foot Pain	Not Unfitting	Residuals, S/P …Release, Left  Ankle	5020-8725	10%	20061023	
GERD	Not Unfitting	GERD with Peptic Ulcer Disease	7304-7346	NSC	20061023	
Hypertension	Not Unfitting	Hypertension	7101	10%	20061023	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Foot Tarsal Tunnel Syndrome and Neuroma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s foot condition began in August 2004 without history of direct trauma, and testing performed in May 2005 diagnosed tarsal tunnel syndrome.  The CI underwent surgical correction on 27 May 2005 and a second surgical revision with excision of a neuroma on 25 January 2006.  Post-operatively, the right foot pain continued. 
At the 18 May 2006 MEB NARSUM examination, 4 months prior to separation, the CI complained of severe right foot pain.  The physical examination (PE) revealed an antalgic gait and tenderness about the middle aspect of the right foot.  Right ankle range of motion (ROM), measured on 13 April 2006, noted dorsiflexion to 8 degrees (normal 20) and plantar flexion to 45 degrees (normal); painful motion was present.  

At the 23 October 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant right foot pain that made it difficult to stand or walk for prolonged periods.  The pain was aggravated by physical activity and relieved by rest.  The PE revealed a normal gait and tenderness about the right foot.  Ankle dorsiflexion was to 10 degrees with pain at the end point; plantar flexion remained normal.     

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 8725 (neuralgia; posterior tibial nerve [tarsal tunnel]), citing moderate pain.  The VA also rated the right foot condition 10%, but dual coded 5020-8725 (synovitis-neuralgia) based on the C&P examination, citing “…incomplete paralysis of foot movements which is moderate or mild.”  Members first discussed the neuroma and concluded that it was not a separate condition for rating purposes, but rather a residual condition from the CI’s initial surgery and thus, was subsumed in the primary condition of tarsal tunnel syndrome.  The PEBs utilization of VASRD code 8725 was appropriate given the definitive diagnosis of tarsal tunnel syndrome, and the panel agreed that the CI’s condition was best characterized as mild or moderate for a 10% rating, but did not rise to a severe level for a 20% 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.  

Contended PEB Conditions:  GERD, Hypertension, and Left Foot Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The GERD and hypertension conditions were not profiled or implicated in the commander’s statement, and did not fail retention standards.  The left foot pain was profiled under “bilateral foot pain” and did not meet retention standards, but it was not implicated in the commander’s statement.  At a physical therapy visit on 19 July 2006, 2 months prior to separation, the examiner noted the CI’s right foot was by far the greatest problem, and that his left foot continued to improve.  The PEB noted there was significant improvement in left foot, and determined it was no longer unfitting.  There was no performance-based evidence from the record that the left foot, or any of the other contended conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s 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 GERD, hypertension and left foot pain, 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.  

XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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