RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX CASE: PD1201943 BRANCH OF SERVICE: ARMY BOARD DATE: 20130313 SEPARATION DATE: 20030101 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (68X/AH-64/Systems Repair) medically separated for a right foot condition. He developed painful bunions in 1998 and eventually required a series of podiatric surgeries. The condition could not be adequately rehabilitated 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); and, the condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the right foot condition (and surgical residuals) as unfitting, rated 20%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with that disability rating. CI CONTENTION: “My pains are continuous and I walk with a cane. I can not play with my kids. I feel as if I could die. I can not keep a job. If only someone could suffer like I am suffering. My knees lock on me, I can hardly walk at time. My wife look at me as if I am a nobody.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting right foot condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Medical Records. The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws. RATING COMPARISON: Service IPEB – Dated 20020913 VA - (2 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Surgical Residuals, Right Foot 5280 20% Hallux Rigidus, Right Foot 5281-5283 20% 20030325 No Additional MEB/PEB Entries Hallux Valgus, Left Foot 5280 0% 20030325 Hemorrhoids 7336 0% 20030325 Other x 7 (NSC) 20030325 Combined: 20% Combined: 20% VARD 20021216 (most proximate to date of separation). ANALYSIS SUMMARY: Right Foot Condition. The CI had a bunion deformity of the right foot that existed prior to service (EPTS). He complained of foot pain in 1998. The CI underwent a series of surgeries, including bunionectomy and osteotomy. Post-operative complications included contractures, adhesions, deformities, nerve entrapment, and ankylosis. He was diagnosed with hallux rigidus of the right great toe, with degenerative joint disease (DJD) at the first metatarsophalangeal (MTP) joint. In spite of treatment, he continued to have right foot problems and an MEB was initiated. His MEB clinical examination was on 23 April 2002. There was moderate to severe pain with attempted range-of-motion (ROM) of the right first and second MTP joints. Total ROM of the first MTP joint was < 30 degrees, and for the second MTP joint it was < 20 degrees. Muscle strength was normal in all intrinsic groups, but only 4 out of 5 in the peroneal and anterior muscles on the right. Neurological exam was otherwise normal. The examiner opined that the CI was unable to perform his military duties due to chronic right foot pain. The CI was seen for follow-up by physical therapy (PT) on 18 October 2002. At that exam, he had a very limited gait, and decreased forefoot mobility. There was sensitivity to manual movement of metatarsals and ankle. Objective findings were nearly identical to his last orthopedic exam. As noted above, the CI was medically separated from the Army on 1 January 2003. Twelve weeks later, he had a VA Compensation and Pension (C&P) exam. He walked into the exam room briskly without a limp, with a cane in right hand. The CI reported that he could perform activities of daily living. When asked to walk without the cane, he walked slowly with a severe limp. The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The PEB and the VA chose different coding options for the right foot condition, but both assigned a rating of 20%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a separation disability rating of 20% for the chronic right foot condition coded 5299-5283 rather than 5280. 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. As discussed above, PEB reliance on the USAPDA pain policy was operant in this case and the condition was adjudicated independently of that policy regulation by the Board. In the matter of the right foot condition and IAW VASRD §4.71a, the Board unanimously recommends a rating of 20% for the right foot condition, coded 5299-5283. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, 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 Status Post Multiple Surgical Procedures, Right Foot 5299-5283 20% COMBINED 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20121127, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxx, AR20130006287 (PD201201943) 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 description without modification of the combined rating or 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 xxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)