RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201323
BRANCH OF SERVICE:  Army	BOARD DATE:  20130416
SEPARATION DATE:  20030604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (88M/Motor Transport Operator) medically separated for left foot injury.  The CI presented in the fall of 2002 complaining of left foot pain.  He reported a sprain that occurred 3 years prior.  He was treated conservatively, but the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left foot injury condition, characterized as “diastasis of the first and second metatarsal base joint and medial and central cuneiform joint diathesis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 as medically unacceptable.  No other conditions were submitted by the MEB.  The PEB adjudicated the condition as left foot injury (moderate) as unfitting, rated 10%.  The CI made no appeals and he was medically separated.

CI CONTENTION:  “I receive 20% for my foot.  But have not been awarded proper compensation for my lower back.  I was diagnosed with spondylolisthesis and have been told my back problems are in relation to my service.  According to my doctors my back condition was not caught by military doctors and that my service in the military from July 98 until June 2003 then from Oct 06 til Dec 2011 affected my back dramatically.  I do not hold the Army 100% responsible but I do feel that my service affected me 75% of what was done to my back.  Please look at my civilian doctor’s notes and my life commitment to the army.  Thanks.” 

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 left foot condition is addressed below; no additional conditions, to include the contended low back condition, 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 Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20030429	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Injury	5284	10%	Diastasis, First and Second Metatarsal Base w/Medial and Central Cuneiform Joint Diathesis Left Foot	5299-5284	10%	STR	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20030624 (most proximate to date of separation [DOS]). 

ANALYSIS SUMMARY:  

Left Foot Condition:  The CI had a long history of left foot and big toe pain initially evaluated in 1998.  On 22 July 2000, he had a left great toe hyperextension injury while landing a 4-wheeler after a jump, without any other injuries, for which he had a left first metatarsophalangeal joint closed reduction of the dislocation in the emergency room (ER).  He was followed up by podiatry and orthopedics.  He continued to have feet pain and numbness with running about 2 miles.  The CI then had another left big toe dislocation due to a motorcycle accident for which he was seen in the ER on 22 July 2000.  He was treated with non-steroidal anti-inflammatory medications, stretching, icing, short-leg non-weight bearing cast, controlled ankle motion walkers, orthotics, and corticosteroid injections without improvement.  His records then fall silent from September 2000 until May 2002 when he was also diagnosed with bilateral severe pes planus.  On 12 July 2002, a MEB was considered.  After a series of temporary profiles a permanent profile was issued on 4 February 2003 for lower extremity, left foot pain, that limited the CI from unlimited walking, running, bicycling, and swimming, wearing a 40 pound backpack, marching, and lifting more than 30 pounds.  His commander’s statement recommended retention, but noted that the CI could not assume prominent leadership roles due to inability to establish physical credibility due to limitations such as conducting and leading physical training, 12 mile road march, and attending air assault school, although he could perform deployments to the field and supervisory tasks.  At the MEB exam, on 24 April 2003, 2 months prior to separation, the CI reported 3 years of pain in the left foot in the area of the base of the first and second metatarsal joint as well as the medial and central cuneiform joint that was not responding to treatment and getting worse over time.  He had swelling and numbness with running and was having difficulty performing his soldier duties and physical training due to discomfort.  He had reached maximal medical therapy and declined surgical option; which was considered reasonable due to the fact that his limitations after surgery would probably be the same as before surgery.  The MEB physical exam noted tenderness of the first and second metatarsal and medial and central cuneiform joints, no hypermobility or laxity in the mid-foot area, normal strength, sensation, and reflexes, normal pulses, no edema, no erythema, no lesions, ecchymoses or ulcerations.  X-rays of the left foot revealed a widening at the base of the first and second metatarsal joint as well as the medial and central cuneiform joint.  There was no VA Compensation and Pension exam performed and the VA rating was made using the service treatment record.  

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD codes and 5284 (other foot injuries) used by both the PEB and the VA.  The VA added code 5299 (rated analogously).  The Board examined the evidence in the medical record and found no evidence of periods of incapacitation in need of emergent medical care except for the actual injuries, restriction of activities of daily living, or any restrictions in ordinary supervisory duties in a field environment that would rise to the level above moderate for a rating in the CI’s favor.  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 left foot injury condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left foot injury condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION	VASRD CODE	RATING	
Left Foot Injury Condition	5284	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130010235 (PD201201323)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA