RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01219
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, tactical aircraft maintenance journeyman, medically separated for “bilateral semi-flexible pes planus”, with a disability rating of 0%.

CI CONTENTION:  “Still having issues with walking on hard surfaces.  Have deteriorating cartilage in knees + below, have had a knee surgery since.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20050715	VARD - 20060314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Semi-Flexible Pes Planus	5276	0%	Bilateral Pes Planus	5276	NSC	20060125	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

Bilateral Semi-Flexible Pes Planus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pes planus began in July 1999 while in the Air Force.  His entrance physical exam, dated 8 February 1999, noted some unidentified foot issue but concluded he was qualified for service.  In January 2003 the CI was fitted with custom foot orthosis and placed on a restricted duty profile, which did not relieve his pain.  Despite treatment with rigid orthoses, pain persisted and CI was referred to Orthopedics, and the examiner recommended a medical discharge, noting the condition had existed all of the CI’s life but was aggravated by military service.  Since the CI had only 5 years of service, the examiner opined this should be classified as a condition that existed prior to service (EPTS).  The MEB NARSUM examination on 21 January 2005, 7 months prior to separation, noted complaints of chronic plantar foot pain bilaterally.  Physical examination showed moderate planus configuration bilaterally symmetric; tendon tenderness with pain on resisted inversion bilaterally; normal strength; mild clots of contracture of digits 2-5 bilaterally; bunion deformity bilaterally; tenderness along the arch and sub-second metatarsal head as well as at the insertion of the anterior tibial tendon bilaterally.  Pulses were present bilaterally.  Diagnoses of chronic semi-flexible flat foot bilateral with secondary posterior tibial tendinitis and capsulitis sub-second metatarsal phalangeal joint were rendered.  The examiner noted the bilateral flat foot condition was EPTS.  The CI rebutted the NARSUM record of pain prior to enlistment that was treated by civilian physician, who recommended foot supports and possible foot surgery.  The CI noted he was very active outdoors prior to enlistment with extensive activities such as construction, hiking, hunting, and sports, prior to joining the military.  He stated that after taking the job of flight line maintainer, which entailed pushing aircraft, the foot pain became worse.  He could not walk in a mall, do chores, play with his nieces or drive a car for 30 minutes due to knee problems and constant pain in his feet, symptoms which were present even during sleep.  He indicated that supervisors placed him in a desk job.  

At the 25 January 2006 VA Compensation and Pension (C&P) General Medical Evaluation, performed 5 months after separation, the CI reported pain beneath the right metatarsal head, pain, cramps and numbness in the arch and ankle and posterior heel bilaterally.  He wore orthotics.  Physical examination showed slight valgus angulation of the first metatarsal joints, but no tenderness about the feet.  There was some slight flattening of the arch bilaterally, but not complete loss of the arch with weight bearing.  Reflexes were normal and there was no focal weakness.  X-ray studies of both feet were unremarkable.  A diagnosis of a bilateral foot condition, EPTS, with no evidence of aggravation by military experiences was rendered. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral semi-flexible pes planus condition 0%, coded 5276 (flatfoot, acquired).  In making its determination, the PEB originally rated the pes planus condition at 10% but made a 10% deduction for a condition which existed prior to service (EPTS) with no service aggravation, thus yielding a 0% rating.  Based on the C&P examination 5 months after separation, the VA determined the CI’s pes planus condition was not service connected and accordingly did not award a disability rating.  The panel noted the PEB assigned a 10% disability rating due to service aggravation of the pes planus condition, which is a congenital condition that doctors opined existed prior to enlistment.  Furthermore the panel noted the presence of inflammatory conditions (tendonitis and capsulitis) that existed 7 months prior to separation but apparently resolved by the time of the C&P exam (5 months post-separation).  The C&P exam characterized the foot condition as “slight valgus angulation…slight flattening of the arch bilaterally.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded by majority that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral semi-flexible pes planus condition.  The minority voter determined that the PEB deduction of 10% was not based on any VASRD-standard evidence, so the PEB was not justified in their deduction.  The minority accordingly voted for a 10% rating.

BOARD FINDINGS:  In the matter of the bilateral semi-flexible pes planus condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01219.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings