Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02362
Original file (PD-2013-02362.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02362
BRANCH OF SERVICE: Army          BOARD DATE: 20140911
SEPARATION DATE: 20040815


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92Y10/Unit Supply NCO) medically separated for bilateral foot pain. The bilateral foot pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. His profile allowed for an alternate aerobic event to satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral foot pain condition, characterized as “ c hronic foot pain, due to plantar fasciitis and peripheral neuropathy” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded six other conditions for PEB adjudication. The Informal PEB adjudicated “ chronic bilateral foot pain following trauma ” as unfitting, rated 20% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditi ons were determined to be not unfitting . The CI made no appeals a nd 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral foot pain condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions 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 Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20040524
 VA - 1 Mos. Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Foot Pain Following Trauma 8799-8722 10%
10%
20%		 Bilateral Feet w ith Plantar Fascia Tarsal Tunnel Syndrome (Claimed as Bilateral Chronic Foot Pain) 5299-5279 10% 20040916
Other x 6 (Not in Scope)
 Other x 12
Combined: 20%
 Combined: 100%
Derived from VA Rating Decision (VA RD ) dated 200 41210 ( most proximate to date of separation )


ANALYSIS SUMMARY:

Bilateral Foot Pain Condition. In Basic Training the CI reported having both of his feet run over by a floor buffer which initiated bilateral foot pain with subsequent development of abnormal lower extremity sensation. Podiatry diagnosed bilateral foot pain consistent with plantar fasciitis (PF) with chronic paresthesia (abnormal sensation). Despite conservative treatment of rest, medication, night splints and orthotic support, his symptoms continued. Bilateral lower extremity nerve conduction studies (NCS) and electromyogram (EMG) tests conducted by neurology were normal. X-rays of both feet revealed incidental findings of bilateral bunions, and were otherwise normal. There was no radiologic evidence of traumatic, inflammatory, or degenerative changes present. At the podiatry narrative summary (NARSUM) examination dated 25 February 2004 (6 months prior to separation), the CI’s chief complaint was “My feet hurt all the time.” His physical examination (PE) revealed full range-of-motion (ROM) in all foot joints, normal feet strength and normal but weak Achilles reflex. Tenderness was present in the arch and plantar aspect of both feet. He was diagnosed with bilateral PF, prescribed a cane for walking assistance, profiled and referred to an MEB. At the neurology NARSUM examination obtained on 26 April 2004 (4 months prior to separation); the CI endorsed significant pain to both feet causing difficulty with prolonged standing. He reported the ability to walk only very short distance and must use his prescribed cane to stabilize his gait. The PE revealed hypoesthesia (abnormally decreased sensitivity) from bilateral mid-calf to both feet as well as hyperpathia (abnormally increased/exaggerated response to painful stimuli) upon the top of both feet. Deep tendon reflexes (DTRs) of the lower extremities were not elicited, although distal motor activity and strength were normal. The neurologist’s impression was a bilateral peripheral neuropathy syndrome.

At the VA Compensation and Pension (C&P) examination obtained on 16 September 2004 (a month after separation), the CI reported pain, numbness, and burning in his feet after prolonged (20 minutes) standing. “His main complaint in terms of his activities of daily living is pain.” The examination revealed tenderness and joint spacing consistent with a Morton’s neuroma (thickened nerve tissue [painful] on the ball of the foot). The podiatrist’s diagnosis was bilateral plantar fascial tarsal tunnel syndrome.

The Board directs attention to its rating recommendation based on the above evidence. Although the PEB titled the condition as “bilateral foot pain” the DA Form 199 revealed that the 20% rating was actually the combined separate ratings of 10% for each foot to include the bilateral factor. Both the PEB and the VA utilized different analogous coding options of 8722 (neuritis; peroneal nerve) at 10% each foot (total 20%) and 5279 (metatarsalgia; Morton’s neuroma) with the sole rating of 10% respectively. Board members carefully considered applicable unilateral or bilateral rating options under both VASRD §4.71a and §4.124. Due to the absent of compensable ROM limitations or other orthopedic joint abnormalities, the Board determined that there were no alternate analogous coding options that were beneficial to the CI under §4.71a. The VA’s use of the Morton’s neuroma code, although anatomically correct per the diagnosis, confers only a maximum of 10%. Despite the various diagnoses, the Board agreed that this case could unequivocally be rated as a neuropathy as per the neurologist diagnosis and that the superficial peroneal nerve was anatomically accurate as to the presenting symptoms. However, absent complete paralysis of the nerve, 20% is the maximum rating if considered “severe” impairment. Members agreed that the evidence of maintaining normal lower extremity distal motor activity coupled with normal strength did not rise to the level of severe (20%) impairment, but rather was more consistent with either mild (0%) or moderate (10%) level. In keeping with the Board’s caveat that the final rating recommendation may not produce a lower combined rating than that of the PEB, members recommend that there be no change in the PEB’s adjudication for the bilateral foot pain 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 §4.124, 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131110, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                 

XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150002554 (PD201302362)

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

Similar Decisions

  • AF | PDBR | CY2012 | PD2012-00402

    Original file (PD2012-00402.pdf) Auto-classification: Denied

    The CI underwent the first MEB exam for bilateral lower leg pain. Alternative coding using the VA rating separating the tendinosis from the Morton neuroma disabilities was also considered reasonable, but would also raise the military- 3 PD1200402 specific issue of fitness when the NARSUM did not specify duty impairment from any mid, or distal foot condition. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation...

  • AF | PDBR | CY2013 | PD-2013-02540

    Original file (PD-2013-02540.rtf) Auto-classification: Denied

    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 record only shows this for the left foot. 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...

  • AF | PDBR | CY2013 | PD-2013-02225

    Original file (PD-2013-02225.rtf) Auto-classification: Denied

    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. RATING COMPARISON : IPEB – Dated 20050404VA* -(~7 Months Post-Separation) ConditionCodeRatingConditionCodeRatingExam Morton’s Neuroma, Left Foot…527910%…Morton’s Neuroma, Left Foot5276-527910%20051219Other x 0 (Not In...

  • AF | PDBR | CY2010 | PD2010-01176

    Original file (PD2010-01176.docx) Auto-classification: Denied

    The Informal PEB (IPEB) adjudicated the chronic right foot pain due to Morton’s neuroma condition as unfitting, rated 10%, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD). Although there were examination findings of hallux valgus and hammer toes (single toes) there were no symptoms or impairment attributed to these abnormalities that would warrant rating under VASRD codes 5280 or 5282, and, if rated using these codes, would not attain a minimum...

  • AF | PDBR | CY2012 | PD-2012-00083

    Original file (PD-2012-00083.rtf) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the bilateral metatarsalgia condition as unfitting, rated 10% for each foot with application of the bilateral factor for a combined 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Thiscondition was noted in the NARSUM and MEB and was clinically tied to the CI’s bilateral unfitting foot condition(s). Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-02609

    Original file (PD-2013-02609.rtf) Auto-classification: Denied

    The bilateral foot condition, characterized as “metatarsalgia, bilateral feet” and “neuroma, left foot,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.A second MEB changed the “neuroma, left foot” to “neuroma, right foot.” No other conditions were submitted by the MEB.The Informal PEB (IPEB) adjudicated “chronic bilateral foot pain diagnosed as metatarsalgia with left sided neuroma, status post neurectomy”as unfitting, rated 10%, with likely application of the Veterans...

  • AF | PDBR | CY2012 | PD 2012 01845

    Original file (PD 2012 01845.txt) Auto-classification: Denied

    The Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW VASRD rating guidelines. Pain management notes in the service treatment record (STR) indicate that post tarsal tunnel release the CI continued with pain in both feet, rated at 6 to 7 out of 10 on the left and 9 out of 10 on the right. At the VA exam bilateral foot sensation was noted to be normal.

  • AF | PDBR | CY2013 | PD-2013-01403

    Original file (PD-2013-01403.rtf) Auto-classification: Denied

    The bilateral foot condition, characterized as “plantar fasciitis (PF)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Board therefore, only reviewed to see if a higher combined rating was achieved with any applicable VASRD code. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2011 | PD2011-00565

    Original file (PD2011-00565.docx) Auto-classification: Denied

    Please re-evaluate my Medical Evaluation Board from the Army and my medical records from my extensive period of active duty service (11 years, 5 months total) as well as VA medical records.” Bilateral Foot Pain Condition . The Board thus recommends separate 10% ratings for each foot under the code 5399-5310.

  • AF | PDBR | CY2013 | PD-2013-02329

    Original file (PD-2013-02329.rtf) Auto-classification: Approved

    The only other bilateral coding choice is 5276 under which the VA conferred separate ratings; but, the code provides for 30% and 50% bilateral ratings. Members agreed that the 5284 code (offering no rating advantage) was less applicable because of the absence of any specific injury to the foot; but, concluded that both tibial neuropathy (code 8725) and plantar fasciitis (code 5310)were significant contributors to the unfitting foot pain. In the matter of the combined bilateral foot...