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AF | PDBR | CY2013 | PD-2013-02609
Original file (PD-2013-02609.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02609
BRANCH OF SERVICE: Army  BOARD DATE: 20150406
SEPARATION DATE: 20051013


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Interrogator) medically separated for bilateral foot pain. The bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). 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 Affairs Schedule for Rating Disabilities (VASRD). A second PEB document changed the “left sided neuroma” to “right sided neuroma” without affecting the rating as previously mentioned. The CI made no appeals and was medically separated.


CI CONTENTION: “Veteran was rated only 10% for one foot. The problem was on both feet. She had a rating of 10% for both feet. See attached form(s): Physical Evaluation Board (PEB) proceedings 1 & 2. I was issued two different DA Form 199’s; one rated 10% for the left foot and one rated 10% for the right foot, but not a combined rating of 20% together.”


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 20050627
 VA - (1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Foot Pain Diagnosed as Metatarsalgia with Right Sided Neuroma, Status Post Neurectomy 5279 10% Bilateral Metatarsalgia 5279 10% 20050919
Hallux Valgus, Right Foot 2280 0% 20050919
Scar, Right Foot, Status Post Neurectomy 7802 0% 20050919
Other x 0 (Not in Scope)
 Other x 13 20050919
Rating: 10%
 Combined Rating: 10%
Derived from VA Rating Decision (VA RD ) dated 200 51114 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The board acknowledges the two MEB and IPEB documents regarding the CI’s neuroma and the confusion between the PEBs and took this fact into consideration when rendering its decision. The CI had bilateral metatarsalgia and surgical excision a right neuroma only. The evidence also supports the presence of a left neuroma, albeit not as strongly. Two DA Form 199s were in evidence; one listed a left neuroma and the other a right neuroma which appears to have been a corrected DA 199; however, the DA Form 199 showing the left sided neuroma has the “Approved for the Secretary of the Army” stamp. The Board brings this to the attention of the reviewing authorities for consideration of administrative correction, but notes that this did not affect the adjudication by the Board.

Bilateral Foot Pain with Right Foot Neuroma. The CI had a history of right sided foot pain dating back to 2000 which was treated with physical therapy (PT), medications, orthotics, and duty restrictions without adequate relief. An evaluation in podiatry on 14 March 2002 noted bilateral foot pain, right greater than left, with a palpable mass on the right (neuroma, an overgrowth of the nerve). A magnetic resonance imaging on 17 December 2002 noted some degenerative changes in the bones, but no soft tissue mass (the neuroma). A bone scan performed on 29 July 2003 was remarkable for signs of overuse (the CI was a runner). In September 2003 the neuroma was excised and she was referred to PT for rehabilitation. A weight bearing X-ray of the feet on 29 October 2004 was remarkable for bilateral bone spurs, seen in plantar fasciitis, and bilateral flat feet (pes planus). Despite the surgery and other treatment, she continued to have pain and was referred for a MEB. At the MEB examination on 28 February 2005, the CI reported bilateral foot pain. The examiner noted discomfort for both feet at the base to the second and third toes. No mass was present on the left; a scar was on the right. The narrative summary was on 30 March 2005, just over 6 months prior to separation. The CI reported the onset of right foot pain in 1999 and left foot pain in 2002. The surgery of her right foot did not provide pain relief nor did orthotics. She did enjoy some benefit from a shoe of comfort vice boots, but this was minimal (from 8/10 to 7/10). On examination, the neurological and range-of-motion (ROM) examinations were normal, but there was tenderness over the balls of both feet (metatarsals), 2-4 on the left, and 1-3 on the right with increasing tenderness on the right moving away from the great toe. No mass was documented on the left side. She was thought to have bilateral metatarsalgia and a neuroma of the left foot. At the VA Compensation and Pension examination performed on 19 September 2005, 3 weeks prior to separation, the CI reported bilateral foot pain which limited walking. The examiner noted tenderness over the metatarsals and between the second and third toes (side not recorded). The ROM and gait were normal. The CI was not using orthotics. The examiner also noted minimal hallux valgus (bunion) on the right and a well healed scar on the right foot, from the neuroma resection, which was asymptomatic.

The Board directed attention to its rating recommendation based on the above evidence. It first considered if both feet were separately unfitting. It noted that the CI was profiled and separated for bilateral metatarsalgia. This supports a finding that each foot was separately unfitting. However, the Board determined that the code 5279 (metatarsalgia), used by both the PEB and the VA, is the best fit for the disability in evidence at separation. The 10% rating adjudicated by both the PEB and VA is the highest rating under this code for either a unilateral or bilateral condition. Accordingly, there is no advantage to the CI to separate the bilateral metatarsalgia into two unfitting conditions. Neither the hallux valgus (not in Scope) nor the scar rose to the level of being separately unfitting. 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 metatarsalgia with a right sided neuroma, status post neurectomy.


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 metatarsalgia with a right sided neuroma, status post neurectomy, 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 20131204, 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, AR20150012717 (PD201302609)


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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