RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02370
BRANCH OF SERVICE:  Army	BOARD DATE:  20150127
SEPARATION DATE:  20080414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Basic Trainee) medically separated for a bilateral foot condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standard.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral foot contusion status post crush injury” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “bilateral metatarsalgia” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions found unfitting and not unfitting by the physical evaluation board.”

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 20100803 | VA* - (~3 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bilateral Metatarsalgia | 5279 | 10% | Bilateral Metatarsalgia with Mild Degenerative Changes | 5279 | 10% | 20080701
Other x 0 (Not In Scope) | Other x 11 (Not In Scope)
RATING:  10% | RATING:  10%
*Derived from VA Rating Decision (VARD) dated 20081015 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:  

Bilateral Foot Condition.  The service treatment record (STR) noted that the CI injured her feet while on an obstacle course in November 2007 when another participant fell on top of her.  Although X-rays were normal, a bone scan performed in December 2007 revealed stress changes in both feet, left > right.  Other diagnoses to include osteoarthritis, arthralgia, tendonitis, and soft tissue foot pain were also entertained within a 5-month period.  The CI was not a surgical candidate and despite conservative treatment of medications, physical therapy, immobilization, orthotics, and activity restrictions, her painful symptoms continued and she was referred for an MEB.  At the narrative summary examination (2 months prior to separation), the CI’s chief complaint was “bilateral foot pain.”  The physical examination revealed tenderness across the entire bottom aspect of both feet to include her ankles.  There was painful motion about both ankles and metatarsal-phalangeal joints upon dorsiflexion and plantar flexion.  Tiptoe and heel walking additionally induced pain.  The diagnosis was bilateral foot contusion (bruising) status post crush injury.  The examiner stated, “Due to bilateral foot pain, this [CI] cannot be expected to carry the loads expected of her in a training environment or perform military duties.”  A commander’s statement was absent from the case file.  Her permanent profile listed bilateral foot stress changes as the diagnosis.  

At the VA Compensation and Pension examination (2 months after separation), the CI reported bilateral foot pain with prolonged standing and walking.  The CI also endorsed weekly painful “flare-ups,” lasting less than 24 hours.  Her functional impairment secondary to flare-up symptoms was listed as “none.”  The examiner documented a normal gait and bilateral foot tenderness.  There was no evidence of painful motion, swelling, instability, weakness, abnormal weight bearing, or atrophy to either foot.  There was no documentation of abnormal range-of-motion in either foot.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB code, 5279 (metatarsalgia), allows for a single rating of 10% applied either unilaterally or bilaterally.  Board members first deliberated if the left and right foot, having been de-coupled from the combined PEB adjudication, remained separately unfitting and therefore subject to a rating.  The objective clinical STR evidence remained equivocal to both feet without a clear indication of one foot significantly more impaired than the other.  Board members agreed that it would be highly speculative to conclude that the disability separately confined to either foot would have rendered the CI incapable of performing her military duties.  Member consensus reasonably surmised the combination of both feet was the condition, which rendered her unfit for continued military service.  Board members agreed on a combined rating conceding VASRD §4.40 (functional loss), based upon the CI’s reported complaints of painful symptoms upon walking.  The most reasonable and appropriate bilateral coding for this case remains the PEB’s choice of 5279, which confers a 10% rating for bilateral impairment.  None of the other foot codes available in VASRD §4.71a were applicable to the CI’s diagnoses or disability.  There was no evidence of a ratable peripheral nerve impairment or documentation of incapacitating episodes, which would provide for additional or higher rating.  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 disability rating for the bilateral foot 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 bilateral foot 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 20140523 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, AR20150010598 (PD201402370)

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

PD-2014-02370