RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03797
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheeled Vehicle Mechanic, medically separated for “bilateral foot pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

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 upon a 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 - 20031008	VARD - 20050401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5399-5310	10%	Mild Pes Planus, Bilateral, S/P Bunionectomy, Left Foot, with Degenerative Joint Disease 1st Metatarsophalangeal Joint, and Hallux Valgus Right Foot	5276	10%	20041012	
		10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s was initially seen for foot pain in 1997.  He was subsequently seen numerous times for bilateral foot and toe pain.  In April 2002, he was unsuccessfully surgically treated for hallux rigidus (restricted mobility of big toe metatarsophalangeal joint).  Radiographic (X-rays) imaging in February 2001 revealed pes planus (flatfoot) and bunions (inflammation and enlargement of first metatarsophalangeal joint of big toes).  Bone scan revealed mild uptake bilaterally of the first metatarsophalangeal joints (L>R) as well as degenerative joint disease.  Despite treatment, the bilateral foot pain 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 “chronic plantar fasciitis bilateral” for PEB adjudication.  At the 28 July 2003 MEB NARSUM examination, 5 months prior to separation, the CI reported chronic bilateral foot pain, and inability to ruck, or run.  Physical examination showed full range of motion (ROM) of the lower extremities and feet. The bilateral foot examination revealed plantar surface tenderness, discomfort on manipulation of the great toe metatarsophalangeal joints, obvious pes planus, and a well healed surgical scar (left foot).  

At the 12 October 2004 VA Compensation and Pension (C&P) examination, performed 9 months after separation the CI reported pain in both feet, and after about one mile of walking, the pain could flare-up.  Pain did not keep him from doing any activity or miss work.  The physical examination documented the CI ambulated well with a full stride. He wore shoe orthotics and there was no abnormal shoe wear.  The bilateral ankle examination revealed a normal appearance with no tenderness.  Bilateral ankle ROM was plantar flexion of 50 (45 normal) and dorsiflexion of 15 (20 normal) degrees bilaterally.  The bilateral foot examination revealed low arches with no tenderness.  The left foot showed a well healed, nontender, and non-adherent surgical scar.  The right foot showed a slight hallux valgus (medial deviation of first metatarsal and lateral deviation/rotation of hallux) with no bunion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% (10% for each foot) rating under an analogous 5310 code (muscle group X injury: moderate), citing multiple etiologies, with diagnosis of hallux limitus, pes planus, and plantar fasciitis, of several years duration and progressive.  The PEB also identified the condition as existed prior to service (EPTS), not permanently service aggravated, compensable in accordance with 10 USC 1207a (eight year rule), rated for plantar fasciitis, and bilateral factor applied.  The VA assigned a 10% rating for the bilateral feet under the 5276 code (flatfoot, acquired) based on the VA C&P examination 9 months after separation, citing treatment for bilateral plantar fasciitis, chronic heel and toe pain, symptomatic progressive hallux limitus, and subsequent surgery for cheilectomy with distal decompression osteotomy and screw fixation, left foot.  

There is no specific diagnostic code for plantar fasciitis (analogizes to 5020).  There was no weakness for consideration under 5277 (weak foot).  There was no evidence of sensory pathology for consideration under 5279 (metatarsalgia).  There was no deformity for consideration under 5278 (claw foot), 5282 (hammer toe), or 5283 (metatarsal bones malunion/nonunion of).  While there was a slight right hallux valgus, the maximum rating for 5280 (hallux valgus) is severe (10%) unilateral (if equivalent to amputation of great toe).  While there was a surgical correction of a left hallux rigidus (rate as hallux valgus), the maximum rating for 5280 (hallux valgus) is severe (10%) unilateral (if equivalent to amputation of great toe).  

The code (5310) used by the PEB characterizes and rates impairment as slight (0%), moderate (10%), moderately severe (20%), and severe (30%).  All Board members agreed the limitations described and examination findings did not exceed a moderate level and discussed whether the condition more nearly approximated the slight or moderate.  Members concluded the bilateral plantar surface tenderness, and discomfort on manipulation of the bilateral great toe metatarsophalangeal joints, on the NARSUM examination favored the moderate over the slight impairment.  The Board also considered the code (5276) used by the VARD for acquired flatfoot.  All members agreed the condition did not exceed the moderate level (10%, unilateral or bilateral).  Under this code, mild (0%) indicates symptoms are relieved with orthotics.  The Board noted the CI’s symptoms persisted with orthotics and the impairment was better described by the moderate level under this code.  The 20% rating under 5276 would require severe unilateral disability with evidence of marked deformity, accentuated pain on manipulation and use, swelling on use, or characteristic callosities.  The Board discussed whether a single 10% rating for the bilateral foot condition under 5276 was more appropriate than a 10% rating for each foot under 5276, 5310 (muscle group X injury), or 5284 (foot injuries other).  The Board concluded the overall disability picture supported a separate 10% rating for each foot as 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 foot pain condition.  

BOARD FINDINGS:  In the matter of the bilateral foot pain 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 20140815, w/attachments
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 
AR20160017234 (PD201403797)

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