RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00248
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Unit Supply Specialist, medically for “left foot pain,” with a disability rating of 0%.

CI CONTENTION:  The CI requests consideration of 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 FPEB - 20020304	VARD - 200805	
Condition	Code	Rating	Condition01	Code	Rating	Exam	
Left Foot Pain	5099-5003	0%	Bilateral Ankle Tendonitis and Strain 	5024	10%	20080108	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Foot Pain Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI entered the service in 2000, and injured his left foot during AIT while running.  The Report of Medical Examination dated March 1999 recorded a prior history of right knee surgery in 1996, and mild asymptomatic pes planus.  He had a normal bond scan with minimal inflammatory changes in both heels of the feet.  His condition was treated with physical therapy and non-steroidal anti-inflammatory medications which were of limited benefit.  He was not a surgical candidate. Despite treatment, the CI’s foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for MEB.  The MEB forwarded “chronic left retrocalcaneal bursitis and right Achilles tendinitis associated with plantar fasciitis with limited range of motion of the left ankle” for PEB adjudication.  At the time of the Orthopedic consultation dated 18 January 2002, the examiner recorded a 1 year history of left heel pain, described as dull and persistent throughout the day, worsening with ambulation.  A physical examination was not conducted.                              

The NARSUM dated 26 November 2001, approximately 5 months before separation, noted that due to the CI’s overall feet condition he was reclassified into supply.   He was unable to run and pass his APFT.  The CI wore a special clog type shoe and was unable to wear combat boots or shoes with heels.  Physical examination recorded normal knees and ankles; focal tenderness over the left retro-calcaneal bursa and right Achilles tendon tenderness on palpation.  Pain in the heel was not noted.  The examiner opined that the combined effect of all impairments interfered with the CI’s ability to run, march, squat or jump, or wear boots and do push-ups.  Although range of motion (ROM) was not measured, the examiner noted there was “limited range of motion of the left ankle.”  Physical therapy note dated 27 February 2002, approximately 3 months before separation, recorded left ankle ROM dorsiflexion to 0 degrees (normal 20) and plantar flexion of 45 degrees (normal).  The examiner noted the single condition of left retro-calcaneal bursitis, as the treating diagnosis.  At that visit, the CI reported he was no longer taking pain medication but that his pain was unchanged.  Physical examination recorded mildly antalgic gait, and left foot tenderness in the Achilles and posterior tibial tendons.

The VA Compensation and Pension (C&P) examination was accomplished more than 5 years after separation, therefore not probative for rating.  The Board directed attention to its rating recommendation based on the above evidence. The FPEB rated the foot condition 0%, coded 5099-5003, noting, the condition existed prior to service (EPTS); however, was permanently service aggravated.  The FPEB opined there was insufficient evidence to support the reported right Achilles tendonitis, thus that condition was omitted from the “post-formal Board 1999.”  Approximately 6 years after separation, the VA granted a 10% disability rating; however, the VA examination was too remote from separation for consideration.  

As noted above, the CI entered the service with mild asymptomatic pes planus which was the basis for the EPTS evidence.  There was no evidence opposing that determination.  The condition was deemed compensable and the CI was granted a 0% evaluation.  The ROM obtained at the PT examination that demonstrated 0 degrees of DF was not consistent with the clinical evidence, therefore, rating the condition under the limitation of motion code (5271) is not supported.  Evidence supporting a rating under the 5270 (ankle, ankylosis) was absent.  However, there was evidence of functional loss supporting a 10% rating (based on §4.40 and §4.45).  There was no VASRD §4.71a route to a rating higher than the 10% under any applicable code.  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 left foot condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left foot pain condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Foot Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150319, 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 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018555 (PD201500248)

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