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AF | PDBR | CY2013 | PD-2013-02540
Original file (PD-2013-02540.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02540
BRANCH OF SERVICE: Army  BOARD DATE: 20141121
SEPARATION DATE: 20050615


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army E-4 (Medical Laboratory Specialist) medically separated for bilateral foot condition. It could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral foot condition, characterized as “bilateral refractory Morton’s Neuroma,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “bilateral refractory Morton’s neuroma and metatarsalgia” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Additional Injuries those were not included in the Medical Board determination. (Nothing Follows)”


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 :

Service IPEB – Dated 20050419
 VA - (6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Refractory Morton’s Neuroma and Metatarsalgia 5279 10% Bilateral Refractory Morton’s Neuroma… 5279 10% 20051020
Other x 0(Not in Scope)
 Other 2# (Not in Scope)
Rating: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 51107 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Bilateral Refractory Morton’s Neuroma and Metatarsalgia Condition. The narrative summary (NARSUM) noted that the CI had pain on his initial reception run which prevented him from completing the run and directly entering Basic Training. He was referred to a physical fitness unit for a week, issued different shoes, and ultimately able to complete Basic Training albeit with ongoing pain with running. He was placed on a walking profile the day after completion of Basic Training and remained on this until separation. A bone scan on 22 July 2002 showed stress changes in both feet. Conservative management was not beneficial and the CI underwent surgery of the left foot on 8 January 2003. He continued to have pain in both feet despite rehabilitation and injections. On 22 July 2004, X-rays of the right ankle showed hardware from a pre-service repair of a fracture. Weight-bearing X-rays on 19 November 2004 were abnormal with bone spurs in front of and behind the heel bone (calcaneus) bilaterally (consistent with plantar fasciitis and Achilles tendinitis). On 10 December 2004, he underwent surgery for right plantar fasciitis. His heel pain resolved, but the bilateral foot pain persisted. Despite conservative and surgical treatment, he was not able to meet duty requirements. The NARSUM was dated 12 February 2005, 4 months prior to separation. The CI reported persistent pain despite treatment. On examination, he had decreased sensation and pain over the balls of both feet in the mid-line. There was no heel pain, but the right heel was tender at the surgery site. He was diagnosed with bilateral refractory (to treatment) Mortons neuroma which was medically unacceptable. At the VA Compensation and Pension examination performed on 20 October 2005, 6 months after separation, the CI reported that he wore special running shoes and shoe inserts, but denied other aids to ambulation in the introduction. However, he stated that he used a cane at times for his left foot in the discussion of the left foot; he was noted to use a cane at the time of the examination to off load the right foot. On examination, he had a limp from a painful right foot and heel. The range-of-motion (ROM) and arch of the right foot were preserved. Examination of the left foot similar to the right with difficulty walking on his toes, but heel walking was not painful. The ROM and arch were normal. Surgical correction of hammer toes was also noted, although the VA noted this for both feet. The record only shows this for the left foot. Claw toes were not present and the hammer toes were noted to be absent on the right and corrected on the left. The Board recognized the inconsistencies in these statements. Hallux valgus (bunion) was present bilaterally at 5 degrees, but reducible.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB and VA both rated the bilateral Morton’s neuroma condition at 10% using the 5279 code. The Board considered the other coding options for the foot, but absent claw foot, multiple hammer toes, or severe hallux valgus, no route to a higher rating than that adjudicated by both the PEB and VA was found. 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 Morton’s 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 bilateral Morton’s 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 20131022, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20150008385 (PD201302540)

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

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