RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00739
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E2, Rifleman, medically separated for “symptomatic bilateral pes planus” with a disability rating of 10%.  

CI CONTENTION:  His conditions continue to worsen and negatively affect his daily activities.  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 confined to 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 - 20050222	VARD – No VA Disability Claim Filed	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Symptomatic Bilateral Pes Planus	5399-5310	10%	No VA evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Symptomatic Bilateral 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 2004 during Infantry school after a 20 kilometer march where he had bilateral feet “swollen to such extreme that he had to have his boots cut off.”  Despite treatment including custom orthotics, the bilateral feet condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “flat foot” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated October 2004, 6 months prior to separation, the CI reported pain in his feet and knee pain to where he could barely walk and after running could “barely limp up the stairs.”  The examiner indicated a history of plantar pain since February 2004 not improved with orthotics, medication or steroid injections.  Physical examination showed pes planus severe.  At the NARSUM examination, dated January 2005, 4 months prior to separation, the CI had a normal gait, but with some external rotation of the feet.  He had severe pes planus with no arch upon standing.  There was some valgus of the hindfoot with external rotation of the forefoot.  There was no reconstruction of the arch on tiptoe stance and the CI had difficulty walking on tiptoes.  Imaging study were reported as showing severe pes planus.  The examiner indicated that the CI had “significant debilitating bilateral pes planus” and “could certainly not run.”  

There was no VA evidence in the record and the CI’s application indicated that had not submitted a VA Disability Claim.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5310 code (muscle group X) for symptomatic bilateral pes planus.  The VASRD has a specific listed code 5276 (flatfoot, acquired) for the CI’s condition and IAW §4.20 (analogous ratings), analogous muscle coding was not predominate (additionally, muscle rating under §4.73 would apply separately for each foot).  

The Board adjudged that there was no significant difference in fitness or rating criteria of one foot over the other and that the “bilateral” rating under code 5262 (flatfoot, acquired) was predominate.  There was insufficient evidence of severe spasm of the tendo Achilles on manipulation to warrant the “pronounced” (50%) pes planus rating.  The Board deliberated between the “severe, bilateral” (30%) and “moderate bilateral” (10%) ratings for the symptomatic bilateral pes planus condition.  The MEB physical and NARSUM physical both indicated severe bilateral pes planus and documented addition functional loss (IAW §4.10, §4.40, §4.45 and §4.59) to justify a 30% rating for bilateral severe flat foot.  There was insufficient evidence of “pronounced” flat foot findings for any higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 30% for the symptomatic bilateral pes planus condition, coded 5276.  

BOARD FINDINGS:  In the matter of the symptomatic bilateral pes planus condition, the Board majority recommends a disability rating of 30%, coded 5276 IAW VASRD §4.71a.  The single voter for dissent recommended modification of the assigned rating and did not elect to submit a minority opinion.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Symptomatic Bilateral Pes Planus	5276	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX   
	(c) PDBR ltr dtd 20 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 26 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 16 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 29 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 20 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.  

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 20 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)