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AF | PDBR | CY2013 | PD-2013-02225
Original file (PD-2013-02225.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02225
BRANCH OF SERVICE: Army  BOARD DATE: 20150210
SEPARATION DATE: 20050518


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Machinist) medically separated for left foot pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards, but he was authorized to perform an alternate physical fitness test (per PROFILE). He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “left foot pain, symptomatic neuroma Morton's type left foot” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated his left foot as unfitting and rated it at 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I J—S-- believe that the rating should be changed because I was left with a permanent disability that affects me daily and not able to maintain gainful employment and or work. I struggle to walk or stand on a daily basis I am currently 90% service-connected I believe I deserve retirement.” “I J—S-- would like the PDBR to note that the Department of Veteran Affairs had awarded service-connection for my unfitting condition and bilateral pes planus which was present at the VA examination of December 19, 2005 which was 7 months from separation which I believe should have been considered in 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 20050404
 VA* - (~7 Months Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Morton’s Neuroma, Left Foot… 5279 10% …Morton’s Neuroma, Left Foot 5276-5279 10% 20051219
Other x 0 (Not In Scope)
 Other x 6
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 60227 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY: .

Left Foot Condition. The CI presented to primary care on 03 September 2003 with a 2-year history of left foot pain. He was referred to podiatry and found to have a neuroma (an abnormal growth of a nerve) over the ball of the third toe on the left (Mortons neuroma) as well as an incidental skin condition. The former was injected with steroids, which were without benefit and the CI declined further injections as well as surgery. He was given orthotics to relieve the pressure over the neuroma. A physical fitness test on 4 May 2004 noted that his weight was 254 pounds, an increase of 61 pounds from accession 3 years earlier. A magnetic resonance imaging (MRI) on 15 October 2004 was remarkable only for a soft tissue mass consistent with the clinical diagnosis of a neuroma. The CI was issued a L3 profile for the left foot neuroma and entered into the MEB process. The commander’s statement dated 23 November 2004, noted that the pain in the left forefoot impaired duty. At the MEB exam, accomplished by a nurse practitioner, the CI reported left foot pain and the possible onset of the same condition on the right. The MEB physical examiner noted bilateral moderate pes planus (flat foot) which was symptomatic. The Board noted that this had not been diagnosed at multiple previous podiatry appointments. The 68 inch CI weighed 220 pounds, a decrease of 34 pounds from the earlier fitness test. Later in December 2004, he also noted pain in the right foot. An MRI was essentially negative (normal). The narrative summary (NARSUM) was dated 10 February 2005, 3 months prior to separation, and performed by an orthopedist. The CI reported left foot pain which increased with activity. No comment was made on the right foot. The examiner observed that there was neither marked pes planus nor marked pes cavus (high arch). The range-of-motion of the ankles was symmetric, but reduced in upward bending (dorsi-flexion). The CI was tender to touch over the site of the neuroma. The left foot Mortons neuroma was thought to not meet retention standards. At the VA Compensation and Pension (C&P) foot examination performed by a podiatrist 7 months after separation, the CI reported the use of orthotics, but denied the use of other corrective devices. He was employed at a job which required that he be on his feet for several hours a day and he needed to take breaks every 2 hours due to pain. On examination, he was thought to have a flexible pes planus and was noted to have an antalgic gait (an abnormal gait to minimize pain). He was thought to have a left Mortons neuroma and bilateral pes planus, the latter painful secondary to compensation from his pes planus. A general C&P was accomplished 3 days later. It recorded that the CI now weighed 290 pounds, an increase of 70 pounds from the MEB examination a year earlier. The action officer observed that this would aggravate the pain in any weight bearing joint or structure. On examination, the gait and posture were normal, a change from the antalgic gait noted 3 days previously. An X-ray of both feet on 12 December 2005, noting bilateral pes planus, was unremarkable and did not show pes planus.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the Mortons neuroma condition at 10% using the code 5279 (Mortons disease) (neuroma). The CI contended for both the Mortons neuroma and bilateral pes planus, noting that the latter was present at the initial C&P examination and also rated by the VA (although post-separation). At the time of separation the VA combined the bilateral pes planus condition and Mortons neuroma for a 10% rating using the dual code 5276-5279, (pes planus) and Mortons Disease. The Board considered if the bilateral pes planus condition was related to the Mortons neuroma. Mortons neuroma appears to be caused by repetitive trauma to the forefoot. Risk factors for include impact sports which place pressure on the balls of the feet, pes planus or cavus, and tight shoes. Pes planus was not documented in the record prior to separation other than on the MEB examination. Neither the orthopedist who did the NARSUM examination nor the treating podiatrist recorded this diagnosis. As noted above, the pes planus was not considered by the PEB or MEB and is, therefore, not in Scope as an independent condition. The evidence does not support the addition of pes planus as a related condition to the unfitting Mortons neuroma either. It was not profiled, noted by the commander, treated on active duty, found to fail retention standards by the MEB, or even noted by the MEB orthopedic examiner. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the Mortons neuroma 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 Mortons neuroma 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 20131026, 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, AR20150010418 (PD201302225)


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

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