RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01887
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “bilateral food pain secondary to pes planus,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that his bilateral foot condition continues to be problematic and that his right shoulder should have been rated.  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 - 20031120	VARD - 20040902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5299-5276	10%	Bilateral Pes Planus with Plantar Fasciitis	5299-5276	10%	20040525	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in early 2003 without history of direct trauma.  His original complaint included pain and difficulty with walking.  

On 9 September 2003, 4 months prior to separation, both the MEB examination (recorded on DD Forms 2807 and 2808) and the NARSUM were performed by the same provider whereby the CI reported intense bilateral foot pain on a daily basis.  The CI’s physical examination (PE) revealed overt flat feet with tenderness along the length of the plantar fascia, bilaterally.  His gait and strength of both feet remained normal.  His diagnosis was reported as severe plantar fasciitis with bilateral pes planus.  The NARSUM provider additionally noted, “It should be pointed out that [the CI] was highly motivated despite obvious pain in his feet. He was able to complete some rather aggressive training.  He did do his best to participate in the Gulf War and fulfill his obligation. At this point however given his profound flat feet and the persistence of his symptoms, it is felt that perhaps the active military lifestyle is not appropriate for this soldier.  His condition should be considered chronic and stable.”  
  
At the 25 May 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant bilateral foot pain, weakness, stiffness, swelling and fatigue.  His functional impairment included the inability to run or stand for prolonged periods of time.  His PE revealed the existence of bilateral flat feet.  Tenderness was present about both plantar surfaces.  There was no comment with regards of the severity of either condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the bilateral foot condition as a single unfitting condition analogously coded 5299-5276 (flatfoot; acquired) and rated 10%.  The condition was specifically cited on the DD Form 199 as, “There is sufficient evidence to support a finding that the current impairment EPTS (existed prior to service) and was subsequently aggravated by such service, and rendered the Soldier unfit.  Based on the health records, this condition was permanently aggravated by his deployment to Iraq.”
  
The panel first determined if the PEB’s approach of combining both foot conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each foot, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be found unfit because of a physical disability.  Panel members carefully considered the CI’s ongoing subjective symptoms as well as his progressive worsening overall physical condition and concluded that either foot, independently, would have rendered the CI incapable of satisfactory performance of his military MOS.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that each foot would support a separately unfitting condition.  

Members agreed that the primary VASRD code corresponding to flatfeet was appropriate in this case and in the absence of extreme tenderness of the plantar fascia or marked deformity of the foot, the impairment levels of pronounced or severe were not applicable.  In consideration of the remaining categories of either mild or moderate impairment, all panel members agreed that the un-relieved foot symptoms would indeed support above that of a mild condition; therefore, all members concluded that categorizing the CI’s bilateral flatfoot condition as ‘moderate’ at 10% was appropriate.  

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel unanimously 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009246, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure