RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00263
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050322

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Gas Turbine Systems Technician - Mechanical, medically separated for “bilateral congenital pes planus,” 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 - 20041130	VARD - 20060818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Congenital Pes Planus	5279	20%	No VA Placement	
Bilateral Plantar Fasciitis	Cat II	Bilateral Plantar Fasciitis	5276	10%	20060526	
Bilateral Tarsal Tunnel Syndrome		Left Tarsal Tunnel Syndrome with Degenerative Changes of the Left Ankle	5003-8521	10%		
		Right Tarsal Tunnel Syndrome with Degenerative Changes of the Right Ankle	8521-5003	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Congenital Pes Planus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in 2002.  Following left foot plantar fascia and tarsal tunnel surgery on 4 October 2004 (6 months prior to separation) further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral congenital pes planus” for PEB adjudication.

Post-operative follow-up of the left foot on 1 November 2004 (5 months prior to separation) reported decreased pain, numbness and tingling since surgery.  He was using a walking boot on the left foot due to the recent surgery.  Examination noted a well-healing surgical wound and foot tenderness.  A test for nerve irritation in the tarsal tunnel was negative.  At a physical therapy evaluation on the same day, physical examination showed tenderness of the surgical incision site on the left, and tenderness of the plantar aspect of the left heel, plantar fascia and medial malleolar area.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 9 November 2004 the CI reported ongoing numbness and tingling in his feet.  Physical examination showed moderate pes planus and a surgical scar in the medial ankle.  

At the 26 May 2006 VA Compensation and Pension (C&P) evaluation, performed 14 months after separation, the CI reported pain located at the bottom of the feet that radiated to the toes.  There was no pain at rest, and physical activity aggravated the condition.  He could not tolerate activities requiring prolonged standing and walking, and required arch supports.  He was involved in a sales occupation for one year.  Physical examination showed a normal gait and no signs on the feet of abnormal weight bearing.  The examiner indicated pes planus and pes cavus were not present.  There was tenderness of each foot, and discomfort with tapping over the left tarsal tunnel.  Regarding standing and walking, the examiner stated “he does not have any limitations.”  Weight-bearing X-rays showed no abnormalities except for pes planus.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated each foot separately at 10%, coded 5279 (metatarsalgia, unilateral or bilateral), and applied the bilateral factor.  The PEB subsumed bilateral plantar fasciitis and bilateral tarsal tunnel syndrome as related Category II conditions under bilateral pes planus.  The Board agreed that these conditions were properly subsumed, since the impairment imposed by either of them was indistinguishable from impairment caused by the primary foot condition.  Even conceding a separate fitness determination, it was noted that separate ratings entail the considerable risk of pyramiding, which IAW VASRD §4.14 is to be avoided.

The VA rated the bilateral plantar fasciitis condition 10% coded 5276 (flatfoot, acquired), based on the VA C&P examination 14 months after separation, citing tenderness and the lack of marked deformity as the rationale.  The VA also assigned a separate 10% rating for left tarsal tunnel syndrome with degenerative changes of the ankle, coded 5003-8521 (degenerative arthritis; paralysis of external popliteal nerve); and a 0% rating for right tarsal tunnel syndrome with degenerative changes of the right ankle, coded 8521-5003.  Since the PEB’s 5279 coding approach provides a maximum rating of 10%, the Board considered other routes to a higher rating.  Under the 5276 code, the “severe” bilateral flatfoot and “objective evidence of marked deformity…indication of swelling on use, and characteristic callosities" stipulations required for the next higher 30% rating were not described by the evidence.  The Board also considered analogous coding for each foot under 5310 (muscle injuries, Group X), which is sometimes used for rating plantar fasciitis.  This code confers a 10% rating for “moderate” and 20% for “moderately severe” muscle disabilities.  All members agreed that the condition was most accurately depicted by the “moderate” descriptor, therefore a 10% rating was warranted.  Likewise, under the 5284 code (foot injuries, other), “moderately severe” was not an accurate description, and the next higher 20% rating for either foot was not supported using this pathway.  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 pes planus condition.

BOARD FINDINGS:  In the matter of the bilateral congenital pes planus 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 20150106, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 13 Dec 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 

						  XXXXXXXXXXXXXXXXXX	     				  			  		  Assistant General Counsel
						  (Manpower & Reserve Affairs)