Search Decisions

Decision Text

AF | PDBR | CY2012 | PD 2012 01918
Original file (PD 2012 01918.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2012-01918
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20140716
SEPARATION DATE: 20010930


SUMMARY OF CASE: The available evidence of record reflects that this covered individual (CI) was an active duty LCpl /E- 3 ( 0621 / Field Radio Operator) medically separated for a left foot injury. The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards . He was placed on limited duty and referred for a Medical Evaluation Board (MEB). “P/T arthrosis LT mid FT S/P ORIF [open reduction and internal fix] of LT Lisfranc injury” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated the post-traumatic arthrosis, lisfranc injury of the left foot as Category I (unfitting), rated 20%. The CI made no appeals and was medically separated.


CI CONTENTION: The CI wrote a lengthy statement in his application which was reviewed by the Board and considered in its recommendations.


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 foot condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any condition 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 Naval Records.


RATING COMPARISON :

Service IPEB – Dated 20010801
 VA* - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Post Traumatic Arthrosis , Lisfranc Injury of the Left Foot 5284 20% Arthrosis Tarsometatarsal Joint Left Foo t, s/p ORIF Lisfranc Injury
5276
 NSC STR
Other x 0 (Not in Scope)
 Other x 0
Combined: 20%
 Combined: 0%
* Derived from VA Rating Decision (VA RD ) dated 200 40616 (most proximate to the date of separation (DOS))


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Post-Traumatic Arthrosis, Lisfranc Injury of the Left Foot Condition. Notes in the service treatment record indicate that the CI injured his left foot in December 1999 when while squatting a heavy load (Howitzer cannon) dropped onto his distal thighs during unloading and he had a Lisfranc injury (fracture or dislocation of one or more of the tarsal metatarsal joints) of the left foot. He was initially casted but eventually underwent ORIF of the first, second and third tarsal-metatarsal joints of his left foot. The narrative summary noted that the CI had persistent pain following surgery and removal of his cast and initially had decreased range-of-motion (ROM) at the ankle. Physical therapy improved the ROM, with normal ankle active ROM and strength noted, but the CI continued to have pain. An orthopedic note on 11 September 2000 noted that X-rays showed early arthrosis of the mid-foot, but left foot x-rays dated 22 January 2001 were reported as normal. A foot specialist consult noted post-traumatic arthritis of the first, second and third tarsometatarsal joints and recommended against-additional surgery of the left foot, noting the CI’s age and recommending fusion be saved for later, if needed.

At the MEB exam on 18 May 2001, approximately 4 months prior to separation, the CI reported pain with walking, being unable to walk more than 50 yards or run at all. The MEB physical exam noted a normal gait with tenderness to palpation at the inside of the foot at the tarsometatarsal joints. ROM of the left ankle and toes was full and sensation and vasculature were intact. The examiner noted there was pain with abduction of the foot toes, but no gap at the joints compared with the right foot.

The original VARD on 16 June 2004, nearly 3 years after separation, did not service-connect the left foot condition due to the CI’s failure to attend a scheduled VA Compensation and Pension (C&P) examination or provide other documentation as requested. The first VA C&P examination on 15 June 2004 was not in the available records. The VARD on 14 August 2004 noted the VA C&P findings of normal ROM of the left foot toes, tenderness of the left mid-foot to palpation and when standing on toes. Left foot X-rays were noted to be negative for degenerative changes. The VA rendered a diagnosis of arthrosis tarsometatarsal joint, left foot, rated 10%. The VARD on 6 May 2006 increased the rating to 20% and the most recent VARD in record continued the 20% rating.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left foot condition 20%, coded 5284 (other foot injuries) and the VA rated initially as not service-connected as noted but subsequently as arthrosis tarsometatarsal joint left foot at 10%, also coded 5284. The Board deliberated the rating of the left foot condition. The CI had painful foot ROM noted and reported pain with use of the left foot. The Board first reviewed to see if a higher rating was achieved coded as 5284. The CI had persistent pain despite ORIF of his tarsal metatarsal joint and was evaluated for surgical fusion of the joint. The surgeon recommended against fusion only due to the patient’s young age. The available ratings under 5284 are subjective and specified as 10% for moderate, 20% for moderately severe and 30% for severe foot injury. The Board considered that at the MEB examination the CI was noted to have a normal gait and the Board opined that a normal gait, even if painful, argued against a severe rating. Therefore the Board agreed the highest rating achieved coded as 5284 was 20% for moderately severe. The Board next considered coding as 5283 (malunion or nonunion of the tarsal or metatarsal bones). The available ratings under 5283 are also subjective and defined as in the previous code. By the same logic noted above the Board agreed that the highest rating achieved coding as 5283 also was 20%. The Board finally reviewed to see if coding as 5099-5003 (analogous to degenerative arthritis) provided a rating higher than 20% but found even generously including all three noted involved tarsal metatarsal joints provided a 10% rating for degenerative changes and painful motion of a single group of minor joints. The Board noted that there was no rating higher than 20% achieved with any other VASRD code for foot impairment IAW §4.71a and no other ratable nerve or muscle impairment of the foot. 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 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 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 20121109, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 15 Dec 14

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC


                                                      XXXXXXXXXXXXXX
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01412

    Original file (PD-2013-01412.rtf) Auto-classification: Approved

    Right 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 right foot condition, the Board unanimously recommends a disability...

  • AF | PDBR | CY2014 | PD-2014-01758

    Original file (PD-2014-01758.rtf) Auto-classification: Denied

    The foot condition, characterized as “chronic right foot pain, s/p ORIF of Lisfranc fractures and dislocations,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.The MEB also identified and forwarded status post right shoulder dislocation and left knee pain as not disqualifying.The PEBadjudicated “chronic right foot pain”as unfitting, rated 10%,with application of the VA Schedule for Rating Disabilities (VASRD).The remaining two conditions were determined to be not...

  • AF | PDBR | CY2012 | PD-2012-01817

    Original file (PD-2012-01817.txt) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX CASE: PD1201817 BRANCH OF SERVICE: ARMY BOARD DATE: 20130315 SEPARATION DATE: 20050114 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistical Specialist), medically separated for a left foot condition. The left foot condition, characterized as “status post left foot bunionectomy with chronic pain,”...

  • AF | PDBR | CY2012 | PD2012-00623

    Original file (PD2012-00623.pdf) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the chronic left ankle pain and back pain conditions as unfitting, rated 10% and 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and AR 635-40. At the C&P examination, the CI reported back pain with activity. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION Chronic Left Ankle...

  • AF | PDBR | CY2012 | PD2012 01849

    Original file (PD2012 01849.rtf) Auto-classification: Denied

    Ratings for unfitting conditions will be reviewed in all cases. The initial VA Rating Decision (VARD) was based on the service treatment records (STR).The Board directs attention to its rating recommendationbased on the above evidence.The PEB and the VA rated pain right fifth metatarsal area as 5299-5279 (metatarsalgia) at 10%. 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;...

  • AF | PDBR | CY2013 | PD2013 00782

    Original file (PD2013 00782.rtf) Auto-classification: Approved

    Six weeks after the injury (18 June 2003), the orthopedic examiner noted the CI was without complaint and the left knee ROM was normal with flexion 0-110 degrees.In November 2005, the CI returned with a 2-week history of left knee pain. Although the examiner noted an effusion on physical examination, the MRI definitively noted, “there is no joint effusion” with evidence of degenerative changes. The Board did not surmise from the record or PEB ruling in this case that any prerogatives...

  • AF | PDBR | CY2011 | PD2011-00905

    Original file (PD2011-00905.docx) Auto-classification: Approved

    The PEB adjudicated the chronic left foot and ankle pain condition and mechanical LBP condition as unfitting, rated 10% and 0% respectively, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Left Foot and Ankle Pain Condition . The PEB’s 0% rating was based on an assessment that the condition was characterized by “slight subjective symptoms only.” The VA’s 20% rating was assigned for “muscle spasm on extreme forward bending, loss of lateral spine motion,...

  • AF | PDBR | CY2009 | PD2009-00469

    Original file (PD2009-00469.docx) Auto-classification: Denied

    Right Foot Condition ) The VA rating also included a 10% rating for the scars on her left foot. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; TDRL at 50% for 12 months immediately following the CI’s prior medical separation (Prestabilization rating of 50% for Unhealed or incompletely healed wounds or injuries--Material impairment of employability likely as required by VASRD (2002) §4.28) and then a permanent combined 30% disability...

  • AF | PDBR | CY2013 | PD-2013-02553

    Original file (PD-2013-02553.rtf) Auto-classification: Denied

    At the VA Compensation and Pension (C&P) examination(performed 9 months after separation) the CI reported prior to surgery the pain level was 9/10 to 10/10. Pain was present 1-2 times a month and there was no pain daily with walking. Physical Disability Board of Review

  • AF | PDBR | CY2011 | PD2011-00902

    Original file (PD2011-00902.docx) Auto-classification: Approved

    PHYSICAL DISABILITY BOARD OF REVIEW The PEB adjudicated the left foot neuropraxia condition as unfitting, rated 20% under code 5284, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Physical Disability Board of Review