RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00561
BRANCH OF SERVICE: Army	SEPARATION DATE:  20060616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Food Service Operations, medically separated for “chronic bilateral foot pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contends for his unfitting bilateral foot pain and a knee condition not identified by either the MEB or PEB.  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 - 20060413	VARD - 20061012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5399-5310	0%	Pes Planus, Bilateral	5276	0%	STR	
			Plantar Fasciitis, Bilateral	5284	0%	STR	
Attention Deficit Disorder (ADD)	Not Unfitting	No VA Placement	
History of PRK			
Orthopedic Fractures as a Child			
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was noted to have asymptomatic pes planus (flat feet) on his accession physical in 1993 (for the USMC).  There were no records in evidence for the feet until a 14 October 2005 podiatry visit for a month long history of bilateral foot pain.  He was found to pronate his feet (rolling them inward) and to have pes planus for which he was issued orthotics and placed on duty limitations.  The next record in evidence is a podiatry visit on 27 January 2006.  He reported ongoing left foot pain and was placed in a short leg walking cast.  His symptoms did not improve and he was referred for an MEB.  The MEB NARSUM examination was dated 8 March 2006, less than 3 months prior to separation.  The CI reported a 4-year history of foot pain aggravated by standing at his job, cook, running, and marching.  Treatment had not been successful.  However, he still worked at his job, avoiding standing greater than 15 minutes, and was able to perform the activities of daily living.  On examination, he was noted to have moderate pes planus with excessive pronation, left greater than right.  Tenderness was present over both plantar fascia.  The examination, including ankle range of motion, was otherwise normal as were X-rays.  The MEB forwarded bilateral plantar fasciitis for PEB adjudication.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral foot pain secondary to plantar fasciitis with underlying condition on pes planus (congenital) as analogous to a Group X muscle injury at 0% for a slight impairment, coded 5399-5310.  The VA rated the CI at 0% for the bilateral pes planus condition, coded (5276), and also rated the CI at 0% for the bilateral plantar fasciitis condition, coded (5284), noting that the CI had failed to report for the scheduled C&P examination.  While two diagnoses were present, the impairment was from foot pain.  This was not apportioned between the two conditions in any examination.  Using the same symptoms for two separate codes is not permitted IAW VASRD §4.14 (avoidance of pyramiding).  The Board then considered which code provided the greatest benefit to the CI for the combined condition as well as if the conditions were severed as separately unfitting conditions.  The Board determined that the evidence does support a finding that the feet were separately unfitting at separation although the left foot was clearly more impairing.  The code 5276 supports a 10% rating for the bilateral pes planus condition.  The code 5284 supports a 10% rating for the left foot at moderate impairment and a 0% rating for the right foot.  The code 5310 also supports a 10% rating for the left foot at moderate impairment and a 0% rating for the right foot.  The Board found no route to a combined rating higher than 10% for the bilateral foot condition and determined that the code 5276 best described the condition clinically although all three codes are applicable.  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 bilateral foot pain condition, coded 5276.  

Contended PEB Conditions:  ADD, History of PRK, and Orthopedic Fractures as a Child.  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 a disability rating of 10%, coded 5276 IAW VASRD §4.71a.  In the matter of the contended ADD, history of PRK, and orthopedic fractures as a child 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 Bilateral Foot Pain…	5276	10%	

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

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018756  (PD201500561)

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