RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00736
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-2, Field Artillery Officer, medically separated for “acquired flat foot” with a disability rating of 20%.

CI CONTENTION:  He was not fully evaluated while in service and his condition continues to worsen.  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 - 20050325	VARD - 20060111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Acquired Flat Foot, Right	5276	20%	Bilateral Pes Planus	5276	0%	20050504	
Stage III Posterior Tibial Tendon Dysfunction	Category II	Right Ankle Strain	5271	10%		
		Status Post Right Foot Tarsometatarsal Fusion, Posterior Tendon Debridement and Calcaneal Osteotomy with Residual Scars 	7802	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY: 

Acquired Flat Foot.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s acquired flat foot (pes planus) condition began as right ankle pain in September 2002 during OCS training.  An orthopedic work-up culminated in a diagnosis of acquired pes planus due to right posterior tibial tendon dysfunction.  Failing conservative treatment, the CI underwent surgical intervention in April 2004.  His post-operative rehabilitation was unremarkable, but he still had foot pain upon running which precluded him from performing unrestricted duty.  The MEB forwarded “tibialis tendonitis” and “flat foot” for PEB adjudication.  At the MEB NARSUM examination on 11 January 2005, 6 months prior to separation, the CI continued to have right foot pain to a degree near that of pre-surgery.  His physical examination (PE) revealed near normal ankle range of motion (ROM) noting a 5 degree loss in dorsiflexion.  There was tenderness about the first metatarsal joint as well as the Achilles tendon.  Motor strength and sensation was normal.  At the 4 May 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months prior to separation, the CI reported constant right ankle pain inhibiting him from running.  He denied that the condition has caused any periods of incapacitation.  His PE revealed limited and painful motion of the right ankle; dorsiflexion of 10 degrees (normal 20) and 30 degrees plantarflexion (normal 45).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the “acquired flat foot” condition 20%, coded 5276 (flatfoot, acquired), citing no specific reason.  The VA rated a “bilateral pes planus” condition at 0% coded 5276 based on the VA C&P examination 2 months prior to separation, citing mild bilateral pes planus with symptoms relieved by built-up shoe or arch support.  The PEB also adjudicated the posterior tibial tendon dysfunction as a related category II condition.  All Board members agreed that the tendon dysfunction was the primary cause for the unfitting flat foot condition.  Additionally, all members agreed that the most appropriate VASRD code in this case was 5276 as adjudicated by the PEB.  All related symptoms and functional impairment of the category II condition were subsumed under the rating for the acquired flat foot condition and therefore, does not warrant consideration as a separately unfitting condition.  Under 5276, there are three descriptions of the condition; pronounced, severe, or moderate impairment.  The clinical physical findings did not support any degree of “pronounced” impairment and the maximum rating under the “severe” category for a unilateral (right-sided) condition was that of the PEB’s current rating of 20%.  There were no additional or alternative coding schemes to a higher rating.  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 right-sided acquired flat foot condition.  

BOARD FINDINGS:  In the matter of the acquired flat foot 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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 25 Apr 17

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

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)