RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01685
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150406
SEPARATION DATE:  20050920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Avionic Systems Journeyman) medically separated for right foot pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued an L4S1 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right foot pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right foot pain secondary to ankle/foot sprain” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB also determined pes planus existed prior to service and rated it as Category II (conditions that can be unfitting but are not currently compensable or ratable).  Tobacco habituation was determined to be Category III (conditions that are not separately unfitting and not compensable or ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The MEB made a mistake on 20 Jun 05 when they gave me a medical separation instead of a medical retirement.  The chronic right foot pain that I suffer from then and now has rendered me unfit for service and I fit the criteria for a higher rating at that time.  Also, I was suffering from PTSD at the time when it was unfairly diagnosed as “anxiety disorder with symptoms of PTSD.”  The MEB notes that I was admitted to Lakeview Hospital in April of 2005 for psychiatric problems.  Since chronic right foot pain and PTSD made me unfit for service and I fit the criteria for a higher rating at that time, I should receive a medical retirement instead of a medical separation.”

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 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 20050809 	VA* - (~5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain Secondary to Ankle/Foot Sprain	5283-5299	10%	Status Post, Avulsion Fracture Right Ankle	5299-5271	10%	20060225	
Pes Planus (EPTS)	Cat II	Bilateral Pes Planus	5276	NSC	
Other x 1 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20060316 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Foot.  The CI was noted to have mild, asymptomatic flat feet (pes planus) at accession.  He was first seen for right ankle pain while in training on 21 October 2002.  He reported a 3-day history of pain and was thought to have irritated the Achilles tendon.  He was next seen a year later on 22 October 2003 when he sprained his right ankle with an avulsion fracture seen on X-ray (a bone fracture when the tendon attaching to the bone separates removing a bone fragment with it).  He was initially treated with non-weight bearing and casting and then by physical therapy (PT).  However, his pain persisted.  At a primary care examination on 7 January 2004, he had persistent soft tissue tenderness.  An X-ray was normal.  A magnetic resonance imaging 3 weeks later on 28 January 2004 showed soft tissue swelling (edema) consistent with the previous injury.  No fracture was detected.  X-rays of the right ankle on 14 April 2004 were normal.  When seen in primary care a week later, he had a normal gait, but continued to report pain.  He again reported persistent pain when seen in PT on 4 May 2004, but had a normal posture, gait, and ankle range-of-motion (ROM).  The strength was normal and the ankle ligaments stable, but trace edema was present.  He was subsequently cleared for a 120 day deployment on 3 August 2004.  The CI was next seen on 17 March 2005 in primary care.  He reported that his pain was exacerbated by running.  On examination, there was no swelling or tenderness.  Instability was not documented and the ROM was normal.  At a follow-up evaluation on 27 April 2005, the gait remained normal, but there was tenderness over the outside of the foot.  A bone scan on 4 May 2005 was normal.  The CI was evaluated in podiatry on 18 May 2005 and noted to have some tenderness, but no edema.  A gait analysis showed excessive pronation (inward roll while walking or running) which was thought to be the source of the pain.  He was referred for orthotics.  At a primary care visit on 7 June 2005, the gait was again normal and the MEB initiated.  The narrative summary was dictated 20 June 2005, 3 months prior to separation.  The CI reported use of the orthotics for 3 weeks with minimal relief.  On examination, he was noted to have flat feet (present at accession), but a normal gait without edema.  At the VA Compensation and Pension examination performed on 25 February 2006, 5 months after separation, the CI reported constant right foot pain which was aggravated by activity.  He had orthotics which provided no benefit.  He used a cane and limped.  He denied instability and stated walking was limited to 1/4 mile.  However, for the flat feet, he reported that this did not bother him and that the use of the orthotics “does the trick for him.”  On examination, he had no areas of tenderness and the ROM was normal.  He did walk with a limp.  X-rays of the feet and ankles were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right foot pain at 10% using the codes 5283-5299 (analogous to malunion of the tarsal bones) and 5299-5271 (analogous to limited motion of the ankle), respectively.  The Board reviewed these codes and the others available for the foot and found no route to a higher rating.  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 chronic right foot pain.

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 chronic right foot pain 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 20131023, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear XXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01685.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Attachment:
Record of Proceedings

cc:
SAF/MRBR