RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03355
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “chronic bilateral foot and ankle pain secondary to EPTS [existed prior to service] foot deformity (pes planus), plantar fasciitis and gastrocnemius equinus,” with a disability rating of 0%.  

CI CONTENTION:  “Please consider 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 based on 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 - 20041119	VARD - 20050709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot and Ankle Pain…	5399-5310	0%	Bilateral Pes Planus with Plantar Fasciitis	5276	10%	20050317	
Depressive Disorder	Not Unfitting	Posttraumatic Stress Disorder	9411	50%	20050318	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot and Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral plantar foot pain, ankle pain and leg pain began in 2000 without a history of injury.  She had worsening pain over time.  Despite treatment, the bilateral foot and ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “plantar fasciitis symptomatic with military activity,” “pes planus,” and “gastrocnemius equinus” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2004, 5 months prior to separation, the CI reported activity causing bilateral foot and ankle pain and wear of foot orthotics.  Physical exam showed moderate bilateral pes planus with bilateral tenderness to palpation over the plantar and first metatarsal areas.  The MEB NARSUM examination on 8 September 2004, 4 months prior to separation, noted complaints of bilateral foot and leg pain, with 5/10 daily pain standing over 15 minutes or walking over 5 minutes not relieved by orthotics or conservative treatment.  X-ray of the ankles were normal.  Diagnostic imaging of the feet abnormalities of the bilateral tibial sesamoid (bipartite or non-union) with increased focal uptake (bone scan) in the tibiotalar joint space; right greater than left.  Physical examination showed moderate pes planus foot deformity bilaterally with stance.  There was crepitus on ankle range of motion testing, with limited ankle dorsiflexion to less than 10 degrees of ankle dorsiflexion with the knees straight and greater than 10 degrees with the knees flexed.  Strength, sensory, and dermatologic exams were normal.  There was no pain with strength testing against resistance, and no pain with palpation to the feet.  The CI could perform heel-raise test without pain.  

At the 17 March 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported pain with standing and walking with stiffness in and swelling in the feet.  Weight bearing X-rays revealed early bunion formation and mild hallux valgus angulation.  Physical exam showed a normal gait.  There was mild flat feet deformities with fair weight bearing alignment of the Achilles tendon, which could be corrected by manipulation, and there was no pain with manipulation.  There was tenderness in the plantar fasciae.  There was evidence of hallux valgus.  Bilateral ankle range of motion was painless and full.  There was no tenderness in the metatarsal heads, no evidence of high-arch or claw-feet deformities, hallux rigidus or pes cavus.  There was no evidence of painful motion, edema or disturbed circulation.  The examiner opined that the CI would require the use of inserts to relieve symptoms.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral foot and ankle pain condition 0%, coded 5399-5310 (Group X, muscle), citing the three MEB conditions (“plantar fasciitis symptomatic with military activity,” “pes planus,” and “gastrocnemius equinus”) as permanently service aggravated and rated as analogous to Group X muscle injury, slight.  The VA rated the bilateral pes planus with plantar fasciitis and mild bilateral hallux valgus condition 10%, coded 5276 (Flatfoot, acquired), based on the VA C&P examination 2 months after separation.  The preponderance of exams in evidence documented tenderness in the feet on exam with mild to moderate pes planus and plantar fasciitis.  Given the CI’s symptoms were not relieved with arch supports, and the Service exams’ categorization of moderate pes planus, the Board agreed that the CI’s bilateral foot and ankle pain condition more nearly approximated the 10% (moderate; bilateral) criteria under code 5276, which includes the MEB-referred “plantar fasciitis symptomatic with military activity,” “pes planus,” and “gastrocnemius equinus” conditions.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the chronic bilateral foot and ankle pain condition, coded 5299-5276.  

Contended PEB Conditions:  Depressive Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or specifically implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic bilateral foot and ankle pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  In the matter of the contended depressive disorder condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Bilateral Foot and Ankle Pain	5299-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140707, 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

21 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017178 (PD201403355)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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