RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01728
BRANCH OF SERVICE:  Army	BOARD DATE:  20150303
SEPARATION DATE:  20040815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Network Switching Systems Operator/Maintainer) medically separated for chronic bilateral foot pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) nor satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Bilateral slight/constant pain of the feet due to idiopathic neuropathy” and “chronic dysthesias of the feet, secondary to idiopathic neuropathy” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral foot pain and dysthesias, due to non-specific idiopathic neuropathy” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

 IPEB – Dated 20040625	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain and Dysthesias	5099 5003	10%	Neuropraxia of the Right Foot with Plantar Fasciitis and Metatarsalgia	8599-8524	10%	20040915	
			Neuropraxia of the Left Foot with Plantar Fasciitis and Metatarsalgia	8599-8524	10%	20040915	
Other x 0 	Other x 0	
RATING: 10%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20041118 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Bilateral Foot Condition.  The service treatment record revealed that the CI twisted his right ankle on 10 March 2003 during a physical training run.  X-rays confirmed no fracture and a diagnosis of sprain was rendered.  Conservative treatment to include pain medication and rest did not resolve his symptoms.  Additionally, absent history of direct trauma, the CI developed left ankle pain in May 2003 which also was initially diagnosed as a sprain.  Over a short period of time his painful symptoms spread about the bottom of both feet to include numbness of the forefoot (toes) of both feet.  Although interim exams indicated additional diagnoses of plantar fasciitis, metatarsalgia, and the presence of bunions, both podiatry and neurology agreed that the CI’s overall worsening symptoms were due to neuropraxia secondary to the wearing of tight-fitting boots.  In May 2004, the CI was permanently profiled with the diagnosis of neuropathy of both feet and restricted to wear soft shoes.  The commander’s statement did not support retention.

At the MEB narrative summary (NARSUM) examination performed on 12 May 2004 (3 months prior to separation) the CI reported the inability to do any of the Army physical fitness testing.  “He is unable to wear boots more than a couple of hours per day. He is most comfortable in soft shoes.”  His condition was listed as “stable.”  The physical exam noted the presence of an antalgic gait, “mild” bilateral pes planus (flat feet), and a right-sided bunion.  There was tenderness along both (right “slightly” worse than left) arches and decreased sensation on the top of both feet.  Proprioception was normal.  Range-of-motion of both feet was normal.  The VARD indicated a 10% rating of each foot (combined 20%) IAW VASRD §4.124a Schedule of Ratings-Diseases of the Peripheral Nerves, and citing a sensory polyneuropathy of each lower extremity.

The Board directed attention to its rating recommendations for the bilateral foot pain condition and debated several options for coding and rating.  The PEB and VA chose different coding options for the condition and both were IAW §4.71a.  The PEB chose to bundle the feet and assign an analogous code 5099-5003 (degenerative arthritis) at 10%.  The VA assigned separate 10% ratings for each foot analogously coded under the peripheral nerve code 8599-8524 (incomplete paralysis of the tibial nerve), presumably with application of §4.40 (functional loss) since no limitation of motion was specifically noted.

The Board first considered if each foot, having been de-coupled from the combined PEB adjudication, remained independently unfitting.  All members agreed that there was reasonable justification that each foot, as an isolated condition with logically identical findings, would have rendered the CI incapable of continued service within his MOS; specifically noting numbness of the forefoot and, accordingly merits separate ratings.  Considering the degree of dysethesia (abnormal sensation) that correlated with the bilateral sensory polyneuropathy as described by the VA, Board members agreed that the chosen peripheral nerve analogously coded under 8524 was an appropriate option IAW VASRD §4.124.  Although the CI ambulated with an altered gait at the NARSUM examination, the absence of any motion limitation did not support a level of impairment above “mild” 10%.  After due deliberation, considering all evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends that each foot be separately adjudicated as follows: an unfitting right foot condition and unfitting left foot condition, each coded 8599-8524 and rated 10%, both IAW VASRD §4.124a.  Additionally, Board members did entertain the VASRD unilateral code of 5284 (foot injuries, other) and determined that the intensity of the CI’s symptoms would support only “moderate” (10%) impairment to each foot; thereby conferring no additional benefit to the Board’s current recommendation under 8524 for a combined 20%.

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 for rating bilateral feet was operant in this case and the condition was adjudicated independently of that policy and instruction by this Board.  In the matter of the bilateral foot condition and IAW VASRD §4.124a, the Board unanimously recommends a change in the rating to 10% and reflect VASRD code 8599-8524 for the right foot and 8599-8524 rated at 10% for the left foot for a combined 20% disability impairment.  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:

CONDITION	VASRD CODE	RATING	
Right Foot Neuropraxia	8599-8524	10%	
Left Foot Neuropraxia	8599-8524	10%	
COMBINED (w/BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131016, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-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 XXXXXXXXXXXXXXX, AR20150011077 (PD201301728)

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			     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA