RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-02267
BRANCH OF SERVICE:  Army                                                                   SEPARATION DATE:  20050214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Linguist) medically separated for “bilateral pes planus…,” with a disability rating of 10%.

CI CONTENTION:  The CI requested consideration of all conditions. The CI’s 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 - 20041104	VARD - 20050512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Pes Planus	5299-5276	10%	Bilateral Pes Planus	5276	30%	20050412	
Cervical DDD	Not Unfitting	Cervical DDD	5003-5242	10%	20050412	
Low Back Pain	Not Unfitting	Chronic Lumbar Strain	5237	NSC	20050412	
Right Patellofemoral Pain	Not Unfitting	No VA Placement	
Headaches	Not Unfitting	Headaches	8199-8100	10%	20050412	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bilateral Pes Planus.  The record shows that the entrance examination did not document the presence of pes planus (flat feet).  The first record in evidence is a primary care note was dated 1 February 2002 which noted a 7-month history of pain in both legs.  The CI was diagnosed with bilateral shin splints and pes planus.  He was given a 30-day duty restriction, medications, and custom orthotics.  On 21 February 2002 follow up, his symptoms were resolving.  He was seen several more times in 2003.  Plantar fasciitis was also diagnosed and treated.  In family practice on 29 April 2004, he reported continued pain if he ran in his boots, but could tolerate running shoes.  In family practice a month later, he noted a 3-year history of foot pain; he requested a new profile as the current one was expiring.  He had been on a L2 profile and an MEB was recommended for a permanent profile.  Bilateral pes planus was noted.  A bone scan on 16 July 2004 showed no uptake in either foot.  An X-ray on 29 July 2004 showed bunions but no other significant pathology.  The Medical Evaluation Board (MEB) examination was accomplished on 13 August 2004.  The CI reported problems with his back and neck; he noted the presence of the pes planus and shin splints without further comment.  He was noted to have moderate, symptomatic pes planus on the examination.  The MEB narrative summary (NARSUM), which was dated the same day, recorded progressive pes planus since 2001 without improvement.  He was diagnosed with moderate to severe pes planus and noted to be tender over the plantar surface and Achilles tendon.  The author referenced the DD Form 2808, but the descriptions do not match.  In podiatry on 27 October 2004, 3 months prior to separation, he was noted to have a good fit with his orthotics and no symptoms (pain free) from either the shin splints or previously diagnosed plantar fasciitis.  He was thought to have mild/moderate pes planus which was compensated.  An X-ray of the feet that day was normal.  The CI was seen in orthopedics on 30 November 2004 for a left ankle injury.  There was a bone fragment noted where a ligament had pulled off of the joint and the CI was recommended to be in a controlled ankle movement walker for 3-4 weeks.  

At the VA Compensation and Pension (C&P) examination performed on 12 April 2005, 2 months after separation, the CI reported pain in his feet if he stood over 20 minutes or walked over amile.  He continued to use custom orthotics.  He was working as a horse trainer, but sat in this job and his feet were not “much of an issue.”  On examination, his carriage, posture, and gait were normal.  On examination, he was thought to have pronounced pes planus when he stood.  However, weight bearing X-rays that day only showed a mild reduction in the arch.  There was no tenderness or painful motion.  He did not have abnormal calluses or abnormal weight bearing on observation.  Pronation was noted when he stood along with 10 degrees of valgus.  Hallux valgus (bunions) was noted to be absent.  The weight bearing line showed 10 degrees of valgus.  The gait was also normal when evaluated by a kinesiotherapist.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral pes planus condition at 10%, coded 5299-5276 (analogous to pes planus).  The VA rated the condition at 30%, also coded 5276, noting the presence of pronation on standing.  The Board considered the criteria for a 30% rating:  severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.  It noted that the podiatry examination documented a pain free condition.  On the VA C&P the gait was normal and this was confirmed separately by the kinesiotherapist.  This is not consistent with a severe condition.  While pronation was documented by the C&P examiner, there was no pain upon manipulation, unusual calluses, or swelling.  The evidence does not support a 30% rating on the C&P examination.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 pes planus condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended cervical spine, low back pain, right patellofemoral pain, and headache conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The commander noted that the CI had a long history of neck, lower leg, and foot pain, but that he was able to pass the fitness test.  The CI was issued a U2 profile for the neck, but the other conditions were not addressed in the profile.  All were found to be medically acceptable by the MEB and the NARSUM examiner.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral pes planus condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended cervical degenerative disc disease, intermittent low back pain, right patellofemoral pain, and headache conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

XXXXXXXXXXXXXXXXX

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AH RC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160008546 (PD201402267)

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