RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01586
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Indirect Fire Infantry, medically separated for “right knee PFPS” and “left flat foot (pes planus),” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contended for PTSD.  His complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB - 20080728	VARD - 20090511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee; PFPS 	5099-5003	10%	Right Knee; PFPS	5257	10%	20081113	
Left Flat Foot (Pes Planus)	5299-5276	10%	Bilateral PF & Flat Feet 	5276	10%	20081113	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right Knee Condition.  In September 2007 the CI developed acute right knee pain while exercising on a leg press machine.  Initial X-rays revealed a knee joint effusion, partial tendon tear, and a contusion (bruise) under the right kneecap as sequelae from a kneecap dislocation.  Follow-up X-rays continued to show abnormal kneecap positioning as well as cartilage defect about the right knee.  Orthopedics diagnosed patellofemoral pain syndrome (PFPS) and recommended physical therapy (PT).  Despite aggressive non-surgical therapy, his pain continued.  He was permanently profiled in May 2008 and was referred to a Medical Evaluation Board (MEB) along with a second musculoskeletal condition.  An orthopedic clinic encounter dated 7 May 2008 noted full ROM with crepitus about the right knee.  At the MEB narrative summary (NARSUM) examination performed on 21 July 2008 (2 months prior to separation), the CI’s prior treatment was chronologically reviewed.  He reported wearing a knee brace and the inability to run, carry a load, or wear body armor.  His physical examination (PE) revealed right knee crepitus, swelling and non-quantified laxity of the patella (kneecap) tendon.  His diagnosis remained ‘right PFPS.’  At the VA Compensation and Pension (C&P) examination performed on 13 November 2008 (2 month after separation), the CI reported pain and swelling to the right knee with activity and prolonged walking.  His PE revealed a normal gait and normal range of motion (ROM). 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5003 code (degenerative arthritis) citing limitation of motion.  Board members first acknowledged that all noted examinations above revealed non-compensable ROM and only the evidence of crepitus at 5 months prior to separation would reflect an indirect finding of painful motion and thus in support of a 10% rating IAW VASRD §4.59.  Therefore, 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’s adjudication for the right knee condition.

Left Flat Foot (Pes Planus).  The CI was diagnosed with bilateral plantar fasciitis (PF) and eventually underwent surgical release of the left plantar fascia on 30 November 2007.  Post-operatively, the CI did well with the majority of the clinical encounters revealing either none to minimal pain or tenderness about the surgical area of the left foot.  A single civilian podiatry examination dated 19 March 2008 (6 months prior to separation) revealed mild edema and tenderness of the left foot.  At the MEB Medical Examination (DD Form 2808) dated 13 June 2008 (3 months prior to separation), the CI’s PE revealed bilateral flat feet with left heel tenderness.  Additionally, there was left foot pain when standing on toes or heels.  The VA C&P examination did not state any abnormal review of symptoms or any left-sided lower extremity issues.  Specifically, “no” was listed for having evidence of flat feet.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same primary code of 5276 (flatfoot; acquired).  The PEB rated the left foot only under this code (unilateral application) at 10% while the VA awarded disability compensation for both feet under this code (bilateral application) for a 10% rating.  Board members first agreed that in the case of an unfitting flat foot condition, the maximum rating would equate to 10% in the absence of ‘marked deformity’ and or ‘characteristic callosities’ under code 5276.  Members additionally considered other codes of either 5022 (periostitis), 5271 (ankle limited motion), and muscle code Group X (5310) and concluded that only the muscle code could possibly rate higher if found at a level of ‘moderately severe’ at 20% impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the description of left foot pain when standing on toes or heel appropriately represented moderate (10%) impairment and therefore, there was insufficient cause to recommend a change in the PEB’s adjudication for left foot condition. 

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left foot 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.  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 20140405, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB			

26 AUG 2016

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, AR20160006760 (PD201401586)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA