RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00136
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic bilateral foot and ankle pain,” rated 10% and 0%, 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 - 20050516	VARD - 20060328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot and Ankle Pain	5399-5310	
10%-L	Bilateral Pes Planus Arthritis Metatarsal Phalangeals, Plantar Fasciitis and Bunion Deformity	5276	30%	20051013	
		0%-R	Left Ankle Strain	5024-5271	10%	20051013	
			Right Ankle Strain	5024-5271	10%	20051013	
Bilateral Equinus Deformity	Unfitting, Not Rated due to pyramiding	Bilateral Equinus Deformity	5284	NSC	20051013	
Bilateral Tinnitus	Not Unfitting 	Bilateral Tinnitus	6260	10%	20051013	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:

Bilateral Foot and Ankle Pain and Equinus Deformity.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in August 2003 after falling during a night jump on an airborne operation.  Radiographic imaging (bone scan) from March 2004 documented diffuse injury of the midfoot, rear foot, and ankles bilaterally.  Despite treatment, the bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “plantar fasciitis bilaterally,” “pes planus deformity bilaterally,” and equinus deformity bilaterally” for PEB adjudication.

At the MEB examination (documented on DD Form 2808 dated 15 December 2004) 7 months prior to separation, the physical examination showed bilateral pes planus and pain throughout the plantar aspect of both feet, left greater than right.  At the MEB NARSUM examination dated 29 December 2004, the CI reported bilateral arch pain worsened by running, prolonged walking, or standing greater than 30 minutes.  The physical examination showed bilateral dorsiflexion to 0 degrees (normal 20).  There was tenderness about the bilateral lateral and posterior ankles, and tenderness of the plantar surface of the bilateral feet (over the medial plantar fascial bands, and proximal insertions into the calcaneus).  There was normal strength and sensation bilaterally with no evidence of edema, erythema, or ecchymosis.

At the 13 October 2005 VA Compensation and Pension (C&P) evaluation (3 months after separation), the CI reported limitations in standing and walking, persistent pain during the day and night, and the use of bilateral orthotics; he denied swelling.  The physical examination showed no abnormal weight bearing, however there was a limping gait, loss of the longitudinal arches while standing and early bunion deformity of the great toes bilaterally.  There was bilateral tenderness along the plantar fascia to its insertion into the calcaneus (heel), left worse than right.  The heel walk was “difficult and painful;” the toe walk was “impossible due to pain.”  Bilateral ankle dorsiflexion was to 15 degrees bilaterally, and plantar flexion was to 40 degrees (normal); both with pain.  Repetition resulted in increased pain, and no decrement in range of motion.  There was no evidence of equinus deformity or instability in either foot.

The Board directed attention to the rating recommendation based on the above evidence.  The PEB individually rated 10% for the left (“moderate”) and 0% for the right (“slight”) foot and ankle pain conditions, and assigned a combined final 10% rating, analogously coded 5399-5310 (muscle group X…plantar).  The PEB further cited pes planus and pain and unfitting equinus deformities that could not be separately rated due to pyramiding.  The VA rated the “bilateral pes planus, arthritis metatarsal phalangeals, plantar fasciitis and bunion deformity” condition 30%, coded 5276 (flatfoot, acquired) based on the VA C&P examination citing “a wide variety of symptoms that cause regular, constant discomfort and pain” to both feet that closely represented a 30% disability.

Members considered other separate analogous coding schemes and concluded that the 5276 code was the best fit given the pathology present.  Although the left foot was noted to be more symptomatic, the foot examinations in all of the medical assessments were similar.  All three examinations documented tenderness along the plantar fascia.  The VA C&P examination was more complete and more proximate to separation, and therefore adjudged to be more probative to rating.  The VA C&P specifically documented tenderness, a limping gait, pain with heel walk and inability to toe walk, with increased pain on repetition.  There was no evidence of “marked” equinus deformity, swelling on use, or characteristic callosities; however, there was documentation of pain on manipulation and pain accentuated on use that would support a 30% rating for the bilateral foot condition coded 5276.  There was no evidence of marked pronation, inward displacement or severe Achilles spasm to support a higher bilateral rating.  There was limitation of ankle dorsiflexion to a right angle (0 degrees) at the pre-separation NARSUM examination that would support a 30% bilateral rating, however there was no evidence of marked contraction, all hammer toes, very painful callosities or marked varus deformity of the bilateral feet for a higher 50% analogous rating under 5278.  There was no evidence of loss of muscle substance or impairment of muscle tone and power for a “moderate…10%” rating; and no evidence of impairment of strength and endurance with loss of muscle substance for a “moderately severe…20%” rating of either foot individually, under the muscle codes (5310) for analogous rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the bilateral foot and ankle conditions, coded 5276.

Contended PEB Conditions:  Bilateral Tinnitus.  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.  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 bilateral foot and ankle conditions, the Board unanimously recommends a disability rating of 30%, coded 5276 IAW VASRD §4.71a.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Pes Planus and Plantar Fasciitis of the Feet	5276	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150114, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018486 (PD201500136)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA