RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01956
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150715
SEPARATION DATE:  20050502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Military Policeman) medically separated for bilateral metatarsalgia.  The bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).   The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board.  The “metatarsalgia, bilateral,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “bilateral metatarsalgia” as unfitting, rated 10%, IAW with American Medical Association (AMA) guidelines.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends that his condition was easily correctable and he should have been allowed to retire. The applicant’s complete submission is at Exhibit A. 

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:  

IEB - Dated 20050112	VA* - (~4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Metatarsalgia	5279	10%	Bilateral Pes Planus	5276	10%	20050106	
Other Conditions x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050728 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Metatarsalgia.  On 14 February 2003 the CI presented with a 2-month history of right foot pain.  There was not history of trauma.  He was diagnosed with Morton’s neuroma (neurogenic foot pain due to nerve irritation).  He was treated conservatively with podiatric care, activity modification, and anti-inflammatory medications.  A steroid injection in April 2003 provided slight symptom relief.  A bone scan performed 15 September 2004 demonstrated an uptake pattern consistent with trauma to the right third and fourth metatarsal.  Despite conservative and steroid injection the CI continued to report right foot pain and swelling and subsequently reported the onset of left foot pain.  At the narrative summary, the CI reported the his feet were very painful when he was required to ambulate for prolonged periods of time and that he was unable to cut the grass, climb stairs, or hike.  The physical examination demonstrated pain on palpation of the planter surface of the feet and the left mid- foot and arch and normal planter/dorsiflexion. The neurovascular examination and muscle strength were normal.  

At the VA Compensation and Pension (C&P) examination performed 4 months prior to separation; the CI reported pain stiffness, swelling and fatigue at rest and with activity.  He also reported loss of work four times a year as a corrections officer.  The physical examination demonstrated no tenderness, painful motion, edema, or weakness in the feet.  There was a finding of pes planus which was confirmed by radiograph.  The examination was negative for Morton’s foot pain (metatarsalgia).  A diagnosis of bilateral pes planovalgus was rendered.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral foot pain condition as a single unfitting condition and rated 10%; coded 5279 (Metatarsalgia, anterior [Morton’s disease], unilateral, or bilateral).  The VA rated the bilateral foot pain condition at 10%; coded 5276 (pes planus, acquired).  Although VASRD §4.71a permits combined ratings, it allows separate ratings for separately compensable extremities.  IAW DoDI 6040.44 if the PEB combined adjudication is not VASRD compliant, each extremity subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for disability rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  The Board noted that the majority of treatment was directed at the right foot pain; however, prior to separation left foot pain was reported and evaluated via radiograph.  The right foot was profiled.  Metatarsalgia without identification of unilateral or bilateral was implicated in the commander’s statement.  Board members agreed that right foot pain demonstrated greater functional limitation than the left and could be reasonably justified as separately unfitting.  Board members agreed that there was insufficient performance based evidence to support a conclusion that the functional impairment from the left foot would have resulted in the CI’s inability to perform the duties of his MOS and therefore, could not be reasonably justified as separately unfitting.  The Board then considered whether the evidence supported a higher than 10% rating for the right foot pain condition.  The Board noted that the highest rating for metatarsalgia is 10%. There was no evidence of moderately severe foot injury or marked foot deformity for a 20% rating under VASRD codes 5284 (Foot injuries, other) or 5299-5276 (analogous to pes planus). 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 bilateral metatarsalgia 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.  As discussed above, PEB reliance on American Medical Association (AMA) guidelines for rating bilateral metatarsalgia condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the bilateral metatarsalgia 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131028, 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, AR20150013345 (PD201301956)

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		XXXXXXXXXXXXXXX
			Deputy Assistant Secretary of the Army
			(Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA