RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02861
BRANCH OF SERVICE:  Army	BOARD DATE:  20150605
SEPARATION DATE:  20060301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Food Service) medically separated for a bilateral foot condition.  The foot condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty, but she was authorized to perform an alternate Army Physical Fitness Test.  She was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB).  The foot conditions, characterized as “painful pes planus” and “chronic painful plantar fasciitis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also forwarded one other condition (recurrent hip pain) for PEB adjudication.  The Informal PEB combined the two foot conditions into a single unfitting condition, rated at 0%.  The hip pain was found to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board review all of her conditions.  Her complete submission is at Exhibit A.  

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 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:  

IPEB – Dated 20051116	VA* - (~22 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pes Planus, with painful Plantar Fasciitis	5299-5276	0%	Bilateral Pes Planus, Plantar Fasciitis, and Hallux Valgus 	5276	10%	20080117	
Chronic Recurring Hip Pain 	Not Unfitting	Bilateral Bursitis, of the Hips 	5019	10%	20080117	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5 	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20080310 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  

Pes Planus, with Painful Plantar Fasciitis.  In July 2003, this CI had onset of bilateral foot pain.  She was diagnosed with pes planus (flat feet) and plantar fasciitis (inflammation of the plantar fascia).  She was treated with arch inserts and injection therapy.  In spite of all treatment efforts, her foot pain persisted and MEB was initiated.  The MEB narrative summary was dictated on 13 October 2005.  Physical examination of the feet showed obvious pes planus, with flattening of the longitudinal as well as the transverse arch.  There was tenderness to palpation of the heel, at the calcaneal insertion of the plantar fascia.  The CI was medically separated from service on 1 March 2006.  In November 2007, 21 months later, she had a VA Compensation and Pension (C&P) exam.  The Board was not able to obtain a copy of that examination.  On 17 January 2008, the CI had a C&P exam of her hips and her varicose veins.  Her feet were not examined at that time. 

The Board directed attention to its rating recommendation based on the above evidence.  The Army PEB and the VA chose different coding and rating options for the bilateral foot condition.  The PEB used diagnostic code 5299-5276 (analogous to flatfoot, acquired), and rated it at 0% (mild, with symptoms relieved by built-up shoe or arch support).  The VA coded it 5276 (flatfoot, acquired) and assigned a 10% rating (moderate, with pain on manipulation or use of the feet).  After a thorough review of the evidence, the Board determined that the CI’s symptoms were not relieved by arch support.  There was sufficient evidence that she did indeed have pain with use of the feet.  Therefore, her foot condition was best described as “moderate.”  There was insufficient evidence to support describing her foot condition as “severe” or “pronounced.”

After due deliberation, the Board determined that a 10% rating was appropriate.  There was no path to a higher rating, because the record had insufficient evidence of a seriously crippling foot disability that would justify a higher rating.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the bilateral foot condition.  It is appropriately coded 5276, and IAW VASRD §4.71a, meets criteria for the 10% rating level.

Hip pain.  The Army PEB adjudicated the hip pain condition as “medically acceptable.”  The Board’s main charge with respect to this condition is to assess the appropriateness of the PEB adjudication.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hip pain condition was thoroughly reviewed by the action officer and considered by the Board.  

The Board determined that the hip pain condition was not specifically profiled, nor was it judged to fail retention standards.  This condition was not implicated in the commander’s statement.  There was insufficient evidence in the record that the hip pain condition significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board found insufficient cause to recommend a change in the PEB fitness determination for the hip pain condition.  Therefore, no additional disability rating is recommended.   

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.  In the matter of the bilateral foot condition (pes planus, with plantar fasciitis), the Board unanimously recommends a disability rating of 10%, coded 5276, IAW VASRD §4.71a.  In the matter of the hip pain condition, the Board unanimously recommends no change from the PEB determination as “medically acceptable” and therefore not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Pes planus, with painful plantar fasciitis 	5276	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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, AR20150018231 (PD201402861)

1.  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 to modify the individual’s disability rating 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA