RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2020-00195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Administrative Specialist, medically separated for “chronic left foot pain” and “chronic low back pain,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  No specific contention was made.  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 - 20061103	VARD - 20071010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain…Status Post (S/P) Calcaneal Navicular Bar Resection and Triple Arthrodesis	5272	10%	S/P Triple Arthrodesis, Left Foot/Ankle	5271	20%	20070403	
Chronic Low Back Pain	5237	10%	Lumbar Strain with DDD	5237	10%	20070403	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Left Foot Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a calcaneal navicular bar resection in 2001 but continued to experience chronic pain despite medications and remaining on profile. He underwent a triple arthrodesis in early 2005 and subsequent subtalar joint fusion screw removal in November 2005.  
 
During the 17 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the physical examination revealed decreased range of motion (ROM) in the left ankle and foot, and decreased light touch sensation along the foot dorsum and second and third digits.  A 20 July 2006 foot X-ray series showed bilateral pes planus and a right Achilles spur.  There were postsurgical changes in the left ankle with arthrodesis and intact fixation screw in the talus, calcaneus, and cuboid.  
The 2 August 2006 MEB podiatry consult noted full left ankle strength in all 4 quadrants bilaterally, and a symmetric pes planus foot type.  The CI was unable to perform a toe raise on the left, and had decreased ability to perform double toe raises and single toe raises on the right.  On the same day, at the MEB orthopedic examination, he reported the inability to run, walk more than three-quarters of a mile, or wear combat boots of any kind.  He had pain on all sides of the left malleoli and numbness over the dorsum of the left forefoot.  Physical examination showed an antalgic gait and the use of a cane for ambulation.  Left ankle strength was at 4/5 with dorsiflexion, plantar flexion, and in the extensor halluces longus.  Measured ROM revealed dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal), with minimal pronation and supination.  The CI reported decreased sensation to light touch over the deep peroneal distribution.  The 4 August 2006 MEB physical therapy (PT) examination recorded left ankle dorsiflexion to 3 degrees and plantar flexion to 30 degrees due to mechanical limit in both planes.  The 21 August 2006 MEB NARSUM examination, 7 months before separation, noted complaints of chronic pain that caused great difficulty with walking, daily activities, and military duty.  The examiner referenced the results of the examinations above.

At the 3 April 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant sharp, aching, and cramping left foot pain rated at 10/10 during physical activity.  Physical examination showed an abnormal gait and left ankle and plantar foot tenderness.  Left ankle dorsiflexion was to 10 degrees and plantar flexion to 10 degrees with pain at the extremes of motion.  After repetition, the joint function was additionally limited by pain, fatigue, weakness, and lack of endurance, with pain having the major functional impact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5272 (subastragalar or tarsal joint, ankylosis), citing good weight-bearing position.  The VA rated the left foot/ankle condition 20%, coded 5271 (ankle, limited motion), citing marked limited ankle motion.   Panel members agreed that a 20% was justified for marked ankle limitation of motion documented at the C&P examination which was most proximate to separation and carried the greatest probative value for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left foot/ankle condition, coded 5271.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI began experiencing low back pain after being struck in the back by a generator in 1998.  A lumbar spine X-ray series on 19 July 2006 showed a small spur at L2-L3 and L4-L5 with mild narrowing of the L5-S1 disc space.  

The MEB orthopedic examiner noted spinous process tenderness and pain increased with forward flexion.  The CI was able to heel walk, but unable to toe walk on his left foot.  Straight leg raise testing was negative and bilateral lower extremity strength was 5/5 with hip flexion, knee flexion and extension.  Deep tendon reflexes were 2+ and sensation was intact to light touch throughout the bilateral lower extremities with the exception of the left foot.  The MEB NARSUM examiner noted CI complaints and referred to the orthopedic consult for physical findings.  

At the VA C&P examination, the CI reported low back stiffness and weakness.  The examiner recorded normal posture with an abnormal gait due to the left foot.  There was lumbar tenderness but no muscle spasm or radiating pain on movement.  Straight leg raise testing was negative on both sides, and measured ROM revealed flexion to 90 degrees (normal) and extension to 30 degrees (normal), with pain at the extremes of motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing full motion and localized tenderness.  The VA also rated the low back condition 10%, coded 5237, based on the C&P examination, citing thoracolumbar spine flexion greater than 60 degrees but not greater than 85 degrees; or, combined ROM greater than 120 degrees but not greater than 235 degrees.  
Panel members agreed there was no limitation of thoracolumbar spine motion to support a 10% rating, and no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour for the next higher 20% rating.  Also, there was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 low back condition.  

BOARD FINDINGS:  In the matter of the left foot condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  In the matter of the low back 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.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Foot/Ankle Pain	5271	20%	
Chronic Low Back Pain	5237	10%	
COMBINED	30%	

The following documentary evidence was considered:

AR20210008297

Dear XXXXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the US Army Physical Disability Agency
(AHRC-DO)

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