RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00108
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Power Generation Equipment Repairer, medically separated for “chronic bilateral foot pain,” with a disability rating of 0%.

CI CONTENTION:  “Review 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 - 20030618	VARD - 20040425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5024	0%	Posterior Tibial Tendonitis Right Foot	5299-5284	10%	20030924	
			Posterior Tibial Tendonitis Left Foot	5299-5284	10%	20030924	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Bilateral Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in 2000 without inciting injury.  The MEB forwarded “bilateral chronic posterior tibial tendonitis” for PEB adjudication.

The MEB NARSUM examination on 31 March 2003, 4 months prior to separation, noted complaints of the CI reported pain in both feet.  Physical examination showed bilateral Achilles tendon tenderness, in front of the tendon, and at the medial plantar surfaces.  Ankle range of motion was normal bilaterally.

At the 24 September 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported daily pain, described as heat like a hot knife on the bottom of his feet, and feet cramping after prolonged standing, running or marching.  He reported shoe inserts did not help. Physical examination showed normal dorsiflexion bilaterally.  There was no evidence of painful motion or additional limitation of motion with repetitive use.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, coded 5024 (tenosynovitis), citing “normal ROM.”  The VA rated the right foot condition 10%, and the left foot condition 10%, both analogously coded 5299-5284 (foot injuries, other) based on the VA C&P examination 2 months after separation, citing subjective complaints of foot pain.  The bilateral rating approach used by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agree that each foot is separately unfitting and that identical coding and ratings are applicable.  The Board noted repeated reports of bilateral foot pain with use with objective tenderness to palpation findings.  Board members agreed the evidence supports a 10% rating for each foot for functional loss IAW §4.40 (functional loss).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right foot pain condition; and 10% for the left foot pain, both coded 5024.

Contended PEB Conditions:  Congenital Coxa Vara (Hip Condition), Genu Valgum (Knock Knee).  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 implicated in the commander’s statement or judged to fail retention standards.  Both of these conditions were identified by the MEB as existing prior to service.  Board member noted that both conditions are congenital conditions.  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 conditions and so no additional disability ratings is recommended.

BOARD FINDINGS:  In the matter of the chronic bilateral foot pain condition, the Board unanimously recommends a disability rating of 10% for each foot, coded 5024 IAW VASRD §4.71a.  In the matter of the contended coxa vara and genu valgum 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 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 Right Foot Pain	5024	10%	
Chronic Left Foot Pain	5024	10%	
COMBINED w/ BLF	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140711, 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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017968  (PD201500108)

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 20% 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