RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00448
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Aircraft Electrician, medically separated for “bilateral foot pain” with a disability rating of 10%.  

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 - 20070207	VARD - 20071210  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5299-5239	10%	Bilateral Flatfeet	5276	10%	20071002	
Hypertension	Not Unfitting	Hypertension	7101	0%	20071002	
Intermittent Right Knee Pain	Not Unfitting	PFS, Right Knee	5299-5260	0%	20071002	
Bunion, Right Great Toe	Not Unfitting	Bunion, Right Great Toe	5280	NSC	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented for medical attention on 25 September 2004, 2 weeks after accession, when he reported a 5-day history of bilateral knee pain.  Both pes planus (flat feet) and a right bunion had been noted on the accession physical, but were asymptomatic at that time.  He was thought to have an overuse injury and referred to physical therapy.  Subsequently, he reported right ankle and foot pain.  He was again noted to have bilateral flat feet and a right bunion.  On 22 February 2005, he reported resolution of his symptoms and requested a return to full duty.  The examination showed a normal gait and non-tender joints with normal motion.  One week later, the CI was evaluated in podiatry and noted to have bilateral flat feet and a right (>left) bunion.  His gait was normal.  He was placed on duty limitations and custom orthotics ordered.  Despite these, duty limitations, and medications, the CI continued to report symptoms.  On 13 February 2006, an X-ray showed bilateral bunions, right > left.  X-rays on 31 August 2006 showed bilateral flat feet.  The commander, in the statement dated 17 November 2006, noted that the CI could do his job and did not recommend medical discharge.  He also noted that the CI’s attitude adversely impacted his duty section.  The MEB NARSUM examination on 21 November 2006, 4 months prior to separation, noted complaints of bilateral foot pain.  He reported that the knee pain had largely resolved with the use of the orthotics and that the right bunion would not preclude duty but for the flat feet.  On examination, the feet were stable but tender.  Moderately severe pes planus was present.  The MEB forwarded “congenital foot deformity pes planus and metatarsalgia” as not meeting retention standards for PEB adjudication.  At the VA Compensation and Pension (C&P) evaluation performed on 2 October 2007, 6 months after separation, the CI reported ongoing foot pain, but that he worked in a machine shop and was on his feet 60-70% of the time without occupational limitations.  He reported that the orthotics aggravated his condition.  On examination, the gait was normal and the examination of the feet unremarkable.  Tenderness, painful motion, edema, weakness, and instability were all absent.  No functional limitations were present with standing or walking.  Weight bearing was normal without pain on manipulation or recorded callosities.  

The Board directed attention to its rating recommendation based on the above evidence.  The (administrative correction) PEB rated the bilateral foot pain condition 10%, coded 5299-5239 (analogous to spondylolisthesis, a back condition).  An earlier PEB had used the code 5279 (metatarsalgia), but also rated the feet at 10%.  The later PEB noted that the CI was rated analogous to metatarsalgia indicating that the 5239 code was an administrative error.  The VA rated the condition at 10% as well, but used the code 5276 (flat feet).  Both codes were determined by the Board to accurately describe the condition, but neither offered a rating advantage over the other.  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.  

Contended PEB Conditions:  Hypertension, Intermittent Right Knee Pain, and Right Great Toe Bunion.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral foot pain condition , the Board unanimously recommends no change in the disability rating of 10%, but recommends that the code be changed to 5279 IAW VASRD §4.71a.  In the matter of the contended hypertension, intermittent right knee pain, and right great toe bunion 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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140521, 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, AR20170001011 (PD201500448)

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,   I accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or recharacterization 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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA