Author: JOHN J. D'ORAZIO
Last saved by: WEATHERS, JANICE R SrA USAF AFRBA AFRBA/AFBCMR
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxx	CASE:  PD1201283
BRANCH OF SERVICE:  Army	BOARD DATE:  20130828
SEPARATION DATE:  20040106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve SSGT/E-6 (73C/Finance Technician) medically separated for a back and right foot condition.  The CI has a long standing history of complaints involving her back and lower extremities.  These conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Low back pain (LBP) and right foot pain conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated chronic LBP and chronic pain right foot conditions as unfitting, rated 10% and 0% respectfully, with application of Veterans Affairs Schedule for Rating Disabilities (VASRD) and US Army Physical Disability Agency (USAPDA) pain policy for the right foot condition.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “Issues for chronic lower back pains conditions should be changed:  chronic lumbar stain, history of degenerative disc disease as thoracic and lumbar condition (to trauma), tumor at T1-T2.  Chronic pain right (continued) foot 0% should be changed for bilateral pes planus right second interspace neuroma and a history of tendinitis.”

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 ratings for the unfitting chronic LBP and chronic pain right foot conditions are addressed below.  The CI also contested left foot pes planus, but this condition was not identified by the MEB or PEB; and, thus is not within the DoDI 6040.44 defined purview of the Board.  Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s sentiment expressed in the CI’s application, that low back and bilateral foot pain conditions should have been characterized differently.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus 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 ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20031015 | VA* - (1 Mos Pre & 3 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic LBP | 5299-5237 | 10% | Chronic Lumbar Strain... | 5243-5237 | 10% | 20040621
Chronic Pain Right Foot | 5009-5003 | 0% | Bilateral Pes Planus... | 5276 | 10% | 20040209
| | | Right Foot Contusion | 5299-5284 | NSC | 20040209
No Additional MEB/PEB Entries | Other x 13 | 20040621
Combined:  10% | Combined:  20%
*Derived from VA Rating Decision (VARD) dated 20040827 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Low Back Pain (LBP).  The CI has a long history of LBP.  In October 2003, 3 months prior to separation from service, she was examined at Ireland Army Community Hospital, Fort Knox, Kentucky.  She was in no acute distress and ambulated without problems.  She was able to heel walk, toe walk, and heel-to-toe walk.  Thoracolumbar range-of-motion (ROM) was measured with goniometer, and is summarized in the chart below.  There was no mention of pain with spinal motion.  A neurologic electrodiagnostic study performed the previous day was normal, and showed no findings suggestive of lower lumbar radiculopathy.

In June 2004, about 5 months after separation, the CI had a VA Compensation and Pension (C&P) exam of her spine.  Her gait was normal, without limp.  There was no spasm, weakness, or scoliosis noted.  There was some pain with extension and with left lateral flexion.  There was no weakness, fatigability, incoordination, or additional ROM limitation after repetitive movement.  Reflexes were normal, and straight leg raise was negative to 80 degrees.  The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Thoracolumbar ROM
(In degrees)

IACH – 3 mos. Pre-Sep
(20031003)

VA C&P – 5½ mos. Post-Sep
(20040621)

Flexion (90 normal) | 90 (110) | 90
Extension (30 normal) | 30 | 20
Rt. Lat. Flexion (30 normal) | 30 (40) | 20
Left Lat. Flexion (30 normal) | 30 (35) | 20
Rt. Rotation (30 normal) | (not listed) | 30
Left Rotation (30 normal) | (not listed) | 30
Combined (240 normal) | -- | 210
Comment | No mention of painful motion | Pain with motion
§4.71a Rating | 0% | 10%

The Board directs attention to its rating recommendation based on the above evidence.  After consideration of the two back examinations noted above, it was determined that both exams had probative value, since both were conducted in a thorough manner, and were performed within 6 months of separation.  Based on the June 2004 C&P exam, and IAW the VASRD §4.71a, a disability rating of 10% is warranted due to combined thoracolumbar ROM greater than 120 degrees but not greater than 235 degrees.  The Board tried to find a path to a higher rating for the LBP condition, but there was not sufficient evidence of a significantly disabling lumbar spinal condition to justify a higher rating.  The Board unanimously agreed that, IAW VASRD §4.71a, a disability separation rating of 10% was warranted for the lumbar condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP (lumbar) condition.
Right Foot Pain.  The CI has a long history of foot complaints.  In July 2003, she was seen by podiatry and was diagnosed with neuroma, second interspace right foot.  In February 2004, a month after separation from service, her feet were evaluated at the Biloxi VA Medical Center.  She reported pain at the distal second metatarsal joint with pressure.  As far as her job, there was minimal impact.  On exam, the only abnormality noted was tenderness to palpation (TTP) at the base of the distal second metatarsal joint.  There were no palpable masses and no inflammation.  No ROM changes involving the toe.  While standing, the CI’s feet were flat on the floor, with approximately 10 degrees of hallux valgus.  There was no TTP in other areas of the feet, and no ROM changes.  There was no evidence of abnormal weight bearing, and no misalignment of the Achilles tendon.  No pain on manipulation of the feet that was associated with ROM.  The examiner’s diagnosis was metatarsalgia, with no significant findings related to her flatfeet.

The Board directs attention to its rating recommendation based on the above evidence.  The Board determined that the February 2004 C&P foot exam carried significant probative value since it was performed just 5 weeks after separation.  Based primarily on information from the February 2004 C&P foot exam, the Board determined that the CI’s right foot pain should be coded as 5279 (metatarsalgia).  Under VASRD code 5279, a rating of 10% is warranted for metatarsalgia, unilateral or bilateral.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right foot pain.  It is appropriately coded 5279, IAW VASRD §4.71 and, meets criteria for a 10% rating.

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 CI’s conditions were adjudicated independently of that policy by the Board.  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic right foot pain and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 10%, coded 5279.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Low Back Pain | 5299-5237 | 10%
Chronic Right Foot Pain | 5279 | 10%
COMBINED | 20%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

xxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxx, AR20130021936 (PD201201283)

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 20% 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						xxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						            (Army Review Boards)

PD1201283