RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD2015-01736
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E7, Special Purpose Equipment Repairer, medically separated for “bilateral pes planus with calluses,” with a disability rating of 0%. 

CI CONTENTION:  “Review all Conditions.”  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 - 20070510	VARD - 20080403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Pes Planus with Calluses	5299-5276	0%	Bilateral Foot Metatarsalgia and Pes Planus with Calluses	5279-5276	10%	20080321	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Pes Planus with Calluses.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began a number of years earlier with a history of bilateral foot surgery in 1993.  “Plantar calluses-recurrent exacerbated” were reported on Standard Form 93 in April 1996 and were likewise noted on Standard Form 88.  Calluses were again reported on DD Form 2807-1 in Jun 2001 and the CI noted the surgery in 1993 was for treatment of calluses “with no success.”  In January 2006 the CI was noted to have hyperkeratosis of below the fifth metatarsal (MT) heads bilaterally as well the first MT head and medial interphalangeal joint of the left great toe.  He also had a soft tissue mass at the dorsal lateral aspect of the right fifth metatarsophalangeal (MTP) joint and a significant hallux limitus and bony deformity on the left foot.  Fat pad atrophy was also present with the MT heads being very prominent.  Scars were present on the dorsum of both feet.  Significant pain was present on the calluses and MT heads. The CI was diagnosed with bilateral metatarsalgia with associated hyperkeratosis.  When deployed in January 2007 the CI experienced severe pain in both of his feet caused by wearing boots and walking on uneven terrain.  A note dated 5 February 2007 indicated the CI had symptomatic metatarsalgia for nearly 15 years and had plans to have repeat surgery, but was deployed.  He was referred to physical therapy but refused any “off the shelf” orthotics.  Evacuation from the theater was subsequently carried out.  At a podiatry clinic examination on 20 February 2007 the CI had fallen arches, excessive pronation of the feet with pes planus, a Tailor’s bunion (bunionette) on the right fifth MT and hallux valgus of the left foot with tenderness on palpation of the plantar aspect of the second MT.  X-rays of both feet on 20 February 2007 demonstrated degenerative changes at the first MTP joint bilaterally.  On 22 March 2007 the consulting podiatrist opined that the CI had numerous calluses secondary to a biomechanical fault which was hereditary and the CI had flat feet.  “Wearing boots, marching, prolonged standing, and running will also aggravate the situation.”  The podiatrist further noted that surgery was not an option at that time, but a trial of custom inserts would be of benefit, but would not be of any help in regard to his military service since he would not be able to perform his duties, pass an Army physical fitness test, or be deployable.  

Despite treatment, the bilateral foot pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB. The MEB forwarded “bilateral foot pain due to chronic callus formation and congenital pes planus” for PEB adjudication.  The 10 April 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints that the CI’s feet hurt and the chronic pain worsened when he jumped off a table onto some hard, uneven surface while deployed.  He indicated his feet ached after prolonged exercise or walking, but took no medication.  Physical examination showed a normal gait with bilaterally moderately severe pes planus and a very small early bunion on the left foot, which was minimally tender and not discolored.  There were no neurosensory or vascular changes of the feet.  On the left foot he had calluses on the plantar surface of the great toe and fifth toe and a callus on the plantar surface of the distal first, third, and fifth MTs.  All were mildly tender to palpation.  The right foot had a callus over the plantar surface of the fifth MT and a soft tissue abnormality, or corn, over the dorsal distal right fifth MT.  While the CI felt he could perform many of the functional military activities, he did admit that any prolonged marching with full field gear would greatly aggravate the pain in his feet.  During the 10 and 18 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808) 1 month prior to separation, the CI reported calluses of both feet, a bunion on the left foot, and surgery on both feet.  Physical examination showed multiple calluses of the feet bilaterally and surgical scars of the feet.   

Electrodiagnostic studies (electromyogram (EMG) and nerve conduction studies) of the left lower extremity were normal on 14 January 2008, 8 months after separation.  At the 21 March 2008 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported severe pain in his feet, sometimes so severe the he was not able to walk.  Nevertheless, was able to work at a civilian job post-separation, albeit he was transferred to another department, which did not involve much walking and where he could sit from time to time.  The examiner found callus build up in the MTP region on multiple toes.  There was severe callus buildup on the right foot just at the margin of the fifth MTP and below the joint.  The calluses were very tender on palpation.  Surgical scars were present at the great toes bilaterally.  There was tenderness of his left ankle on palpation.  X-rays of the feet demonstrated osteopenia (decreased bone mineralization), degenerative changes to the first MTP joints, greater on the left, and a deformity involving the neck of the right fifth MT and an underlying lucency, which could represent an enchondroma.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral pes planus with calluses condition as mild 0%, coded 5299-5276 (flatfoot, acquired), citing the impairment existed prior to service (EPTS) was subsequently aggravated by service.  The VA rated the bilateral foot metatarsalgia and pes planus with calluses condition 10%, coded 5279-5276 (metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral-flatfoot, acquired), based on the C&P examination 10 months after separation, citing the weight-bearing line is over or medial to the great toe with inward bowing of the tendo[n] Achilles (Achilles tendon), and pain on manipulation and use of the feet.  The VA indicated no deduction was necessary for the EPTS permanently worsened condition since the pre-service percentage was zero.  Panel members noted that the CI’s bilateral pes planus with calluses was more than mild since he was precluded from ruck marching, but he did pass a physical fitness test prior to separation.  The VA rated the CI 10% for moderate acquired flatfoot bilaterally.  Panel members had a long and detailed discussion as to whether the CI’s condition rose to the level of a 30% rating for bilateral involvement, which requires “Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.”  The CI had long standing pronation, but no reported swelling, and the calluses were also long standing and were felt to be secondary to a biomechanical fault which was hereditary.  VASRD §4.1 (essentials of evaluative rating) was discussed since the CI worked in a civilian occupation between active duty mobilizations as well post-separation in 2007, albeit he was transferred to another department where he could sit from time to time.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral pes planus with calluses condition, coded 5299-5276.  

BOARD FINDINGS:  In the matter of the bilateral pes planus with calluses condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Bilateral Pes Planus with Calluses	5299-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150627, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008885, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure