Author: JOHN J. D'ORAZIO
Last saved by: BARKSDALE, JAMEILL M GS7 USAF SAF SAF/MRBE
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                                                                                           BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1201849                                                                  SEPARATION DATE:  20030109
BOARD DATE:  20130320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (97B/Counterintelligence Agent), medically separated for chronic right foot pain.  The CI tripped on some stairs and injured his right foot, shortly after being on active duty for a year.  The CI underwent surgery to repair the fracture and subsequently had additional surgery to remove hardware from the initial surgery.  Despite ongoing treatment, the CI 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).  The MEB identified “bone pain secondary to delayed union and bone graft with sural nerve damage and chronic sural neuritis secondary to surgical scar” and forwarded this condition to the Physical Evaluation Board (PEB) for adjudication.  The MEB did not forward any other conditions to the PEB.  The PEB adjudicated “pain right fifth metatarsal area” as unfitting, and rated 10%.  The CI made no appeals and was medically separated with this rating.

CI CONTENTION:  “Nerve damage (RT foot/ankle) due to surgery of broken RT metatarsal. (pinky toe bone/between RT ankle & pinky toe) Rod inserted then removed” [sic]

SCOPE OF REVIEW:  The Board’s scope of review is defined in Department of Defense Instruction (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.  Ratings for unfitting conditions will be reviewed in all cases.  The rated right foot condition as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview.  The CI’s right ankle condition was not recognized by the MEB or PEB and is therefore not within the board’s purview.  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 respective Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20021003 | VA -  rating based on service treatment record (STR) review
Condition | Code | Rating | Condition | Code | Rating | Exam
Right Fifth Metatarsal S/P Fracture and ORIF | 5299-5279 | 10% | Post Op Residuals, Fracture of Right Fifth Toe with Chronic Sural Neuritis | 5299-5279 | 10% | STR
No Additional MEB/PEB Entries | Other x 0 | STR
Combined:  10% | Combined:  10%
VA Rating base on VARD 20030117

ANALYSIS SUMMARY: 

Pain Right Fifth Metatarsal Area Condition.  The narrative summary (NARSUM) notes that the CI had a right fifth metatarsal fracture in October 2000.  He had open reduction and internal fixation (ORIF) surgery due to delayed healing.  He continued to have pain and paresthesias and a second surgery removed the screw in an effort to relieve the symptoms.  Despite this, the CI continued to have pain at the fracture site and along the scar.  The NARSUM stated that the CI was unable to perform all the duties of his MOS because he could not wear necessary foot gear and had “trouble running for long periods of time.”  At the MEB exam on 28 June 2002, approximately 5 months prior to separation, the CI reported cramping of the right fifth toe and sharp pain up the leg that lasts 10 to 15 seconds, 2 to 3 times per day.  He noted bruising, tenderness, decreased sensation, and hypersensitivity along the lateral aspect of the foot and difficulty running.  The MEB physical exam noted a well healed scar and “severe” paresthesias with palpation along the lateral side of the foot.  X-rays showed good healing and alignment.  The DD Form 2808 dated 10 July 2002 noted the right ankle was tender to palpation (TTP), with swelling inferior to the lateral malleolus in addition to tenderness along the lateral foot scar.  There was no ankle instability and full range-of-motion (ROM) of motion was noted.  An orthopedic consult on 12 July 2002 evaluated bruising along the peroneal tendons at the mid forefoot.  Pain and decreased sensation of the lateral foot were noted, but no motor or vascular abnormalities.  The examiner stated “R foot sural neuritis cannot explain the bruising (sic).  This is not why he has pain.  It is the nerve.”  There was no VA Compensation and Pension (C&P) exam near the time of separation.  The initial VA Rating Decision (VARD) was based on the service treatment records (STR).  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and the VA rated pain right fifth metatarsal area as 5299-5279 (metatarsalgia) at 10%.  (the VARD dated 17 January 2003 was based on the STR only).  The Board considered coding as 5283 (malununion of a metatarsal) but X-rays near separation indicated the fifth metatarsal had healed well with good alignment; orthopedic consultation stated that the CI’s foot pain was from the nerve.  The Board opined that the CI’s diagnosed lateral foot sural nerve neuritis, secondary to post-surgical scarring, was comparable to tarsal tunnel syndrome (a compression of the posterior tibia nerve) of the medial (inner side) ankle/foot.  The Board deliberated rating the CI’s right foot condition as 8625 (analogous to neuritis of the posterior tibia nerve) as mild or moderate in the absence of motor involvement.  However, both the mild and moderate ratings of 8625 are 10%.  A higher rating of 20% IAW VASRD §4.123 cannot be assigned in the absence of sciatic nerve involvement, not present in this case.  The Board agreed that the CI’s right foot disability characterized by toe cramping and sharp pain for seconds, a few times a day, and difficulty running did not meet the criteria under 8625 for rating as severe.  Thus, there was not a higher rating achievable coding with 8625 than with the PEB’s coding choice. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right fifth toe pain 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 pain right fifth metatarsal condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

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
Pain Right Fifth Metatarsal Area after Fracture | 5299-5279 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120816, 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 AR20130007791 (PD201201849)

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

PD1201849