RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05225
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050527

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

CI CONTENTION:  “Soreness/discomfort in ankle/foot, numbness, calf muscle, atrophy, surgery after discharge to remove nerve, Achilles tendon disfigured.”  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 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 - 20050415	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain	5311	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Foot Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was noted to have asymptomatic left foot hallux valgus on service entry in 1996.  There are no explanatory records in the available STR, but he underwent corrective surgery (talonavicular fusion with Achilles tendon lengthening) in July 2004, 10 months before separation.  Post-operative provider entries in the STR documented good surgical results without complications, but continued pain with protracted weight-bearing.  Post-operative X-rays (weight-bearing) demonstrated a healed fusion and normal alignment.  Examinations recorded dorsal pain at the fusion site without specifying tenderness or pain on manipulation.  There was a lateral sensory deficit judged to be “a relatively minor or asymptomatic problem.”  There was no note of range of motion (ROM) limitation of the foot or ankle, or of any other VASRD-ratable findings.  There was no note of gait disturbance and the CI was able to tolerate cross-training with weight lifting and elliptical or stationary bike.  

The 2 March 2005 MEB NARSUM examination, 3 months prior to separation, documented the CI “still has continued pain...most closely associated with walking type activities.”  The physical examination recorded pain to deep palpation of the dorsolateral foot adjacent to the surgical site, “mild” localized swelling, and the aforementioned sensory deficit.  There was no note of gait disturbance, ROM limitation, or other positive findings.  There was no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5311 (VASRD §4.73 muscle disability code for Group XI, dorsal foot), referencing DoD and VASRD guidelines.  The 10% criterion of code 5311 is “moderate” disability, and the code offers ratings of 20% for “moderately severe” and 30% for “severe” disability.” The PEB code was a reasonable choice and clinically aligned with the pathology and disability in evidence.  Alternate codes considered by the panel were 5299-5283 (analogous to malunion or nonunion of the tarsal or metatarsal bones) and 5284 (foot injuries, other), but these are rated under the identical scale as elaborated above for code 5311.  The panel agreed the functional impairment in evidence was not reasonably characterized as more than moderate, thus no higher rating was supported under any of these codes.  Panel members further agreed the minor sensory deficit in evidence would not support a separate or higher rating under any VASRD §4.124a nerve code.  There was no ROM limitation or other criterion in evidence that would support favorable rating under any applicable VASRD §4.71a foot or joint code.  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 left foot condition.

BOARD FINDINGS:  In the matter of the left foot condition and IAW VASRD §4.73, 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 that there be no modification or re-characterization of the CI’s disability and separation determination.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05225.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.