RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201246 SEPARATION DATE: 20030731 BOARD DATE: 20130305 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B, Infantry), medically separated for Chronic pain in left hallux, first metatarsal (foot pain). The CI injured his left foot great toe jumping out of his bunk while in training in April 2002 and was diagnosed with metatarsalgia of the left great toe. The CI did not improve adequately with treatment and was unable to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 Profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic pain in left hallux, first metatarsal condition as unfitting, rated 0%. The CI made no appeals, and was medically separated with disability severance pay. CI CONTENTION: “Metatarsalgia is a permanent condition which initially occurred during a training exercise while on duty. The onset was acute and well-documented. The condition was the reason for my medial (sic) board separation and it painfully persists almost I0 years later. I also received a disability rating from Veterans' Affairs within 12 months after my medical discharge.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The rated condition chronic pain in left hallux, first metatarsal, as requested for consideration is the only condition that meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service PEB – Dated 20030625 VA (3 Mos. Post-Separation) – All Effective Date 20030801 Condition Code Rating Condition Code Rating Exam Chronic Pain in Left Hallux, First Metatarsal 5099-5003 0% Chronic Myoligamentous Strain, Left Foot 5284 10% 20031119 Combined: 0% Combined: 10% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. Chronic Pain in Left Hallux, First Metatarsal Condition. The narrative summary (NARSUM) notes the CI reported complaints of left foot pain for 7 to 8 months that had progressively worsened since initial onset. The first note in his medical records of left foot pain was on 18 April 2002 after “jumping out of a bunk bed” and injuring his left great toe. At that time he was diagnosed with left first metatarsalgia, painful left great toe metatarsal phalangeal joint (MTP joint). The X-rays were normal and a bone scan (October 2002) demonstrated “minimal increased radiotracer activity in the greater toe as opposed to other toes.” Activity limiting pain persisted despite treatment with rest, immobilization, medication and injection. The 9 December 2002 Podiatric evaluation recommended continued non-surgical treatment. A clinic examination on 3 January 2003 recorded no swelling, full range-of-motion (ROM) but with pain with great toe MTP joint flexion beyond 60 degrees. At the time of the MEB history and physical examination, 10 March 2003, the CI reported left toe pain with weight bearing. The left first MTP toe joint was tender on examination. The MEB NARSUM examination on 3 April 2003 also recorded tenderness. At the VA Compensation and Pension (C&P) examination, 19 November 2003, 3 months after separation, the CI reported chronic left foot pain, aching in nature and varying in intensity depending on activity. The pain was localized adjacent to the left great toe. On examination there was painful soft tissue swelling on palpation of the dorsum of the left foot immediately adjacent to the great toe. There was normal dorsiflexion and plantar flexion of the great toe. Gait was “steady.” X-ray of the left foot showed no fracture, dislocation, or any other bone abnormality. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left toe pain condition 0% coded 5003. The VA rated left foot pain 10% coded 5284 for other foot injuries. The Board noted the unfitting condition was pain of the left first MTP joint. There was no hallux rigidus, hallux valgus, or fractures. The Board agreed that VASRD diagnostic code 5279, metatarsalgia best matched the unfitting left great toe pain condition. Although there was no limitation of motion, there was pain to palpation and with use supporting the 10% rating available under diagnostic code 5279. The board considered the 5284 diagnostic code used by the VA however a rating higher than 10% was not supported by the preponderance of evidence. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 10% for the left hallux chronic metatarsalgia condition (5279). BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the chronic pain left hallux first metatarsal condition, the Board unanimously recommends a disability rating of 10% coded 5279 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic Pain Left Hallux First Metatarsal 5279 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120703, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130007738 (PD201201246) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)