RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01934
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aerospace Propulsion Apprentice, medically separated for “bilateral foot pain” with a disability rating of 0%.  

CI CONTENTION:  The CI’s conditions continue to worsen.  The 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 - 20051108	VARD - 20061221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain Secondary to Hammer Toes and 5th Toe Tailor's Bunions 	5299-5282	0% 
+ 
0% 	Left Hallux Valgus with Hammertoes	5280	0%	20060612	
			Right Hallux Valgus with Hammertoes	5280	0%		
			Bilateral Pes Planus	5276	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 pain began in December 2004 following repeated dismounting from aircraft.  Podiatry evaluation dated May and July 2005 noted complaints of bilateral foot pain on the outside of the little toe joints bilaterally (5th toe) and the back of the heel.  The examiner noted increased pain in those areas with walking, standing palpation and range of motion.  
There was flexible hammertoe, slight callous build up and erythema on the plantar 5th MP joint (toe to foot) area, and an 8 mm tender nodule at the back of the foot (lateral to the insertion of the Achilles tendon – Haglund’s deformity).  The assessment was “Tailors Bunions” and hammertoe 5th bilaterally.  Surgical intervention was recommended, but the CI declined as there was no assurance it would be curative.  Despite treatment and improved footgear, the bilateral feet condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  

The MEB NARSUM examination on 27 November 2005, 1 month prior to separation, the CI reported bilateral foot pain.  Physical examination showed “bilateral foot tenderness to palpation at 5th toe PIP (proximal interphalangeal) joint and at insertion of Achilles posteriorly.  Hammertoes noted.  Lateral to medial compression of foot increases pain in both feet.”  There was no neurologic deficits.  

At the 12 June 2006 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported pain in the bilateral forefeet without toe pain.  Physical examination showed normal posture and gait.  There was normal toe walking, heel walking, and heel-to-toe walking.  Strength, reflexes and sensation were intact.  There was full ankle range of motion bilaterally.  Feet showed mild pes planus with 5 degrees of hallux valgus on the left and was otherwise normal  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain 0%, coded 5299-5282 (hammer toe), citing each foot separately rated at 0% and a combined 0% rating.  The VA rated the bilateral foot pain with each foot at 0%, coded 5280 (hallux valgus, unilateral), and 0% coded 5276 (flatfoot, acquired), both based on the C&P examination 6 months after separation, citing “symptoms are currently mild.”  

The CI had bilateral little toe deformity (Tailor’s bunions/”bunionettes”), pain in the forefoot and Haglund’s deformity (bump) with pain at the heels, with flexible little toe hammertoes at the NARSUM examination.  By the time of the post-separation VA examination the objective findings were mild bilateral pes planus (flatfoot).  The panel agreed that rating for hammer toes did not warrant higher than 0% for either foot as not all toes were involved.  Analogous rating to code 5282 (bunions) was not greater than 0% as the CI had not had surgery and the Tailor’s bunions were no to the level of “severe, if equivalent to amputation of the great toe.”  Pes planus (5276 - flatfoot, acquired) was not noted pre-separation, but at the VA examination was no greater than “mild” and would not rate higher than 0%.  The panel considered alternative rating under code 5284 (foot injuries, other), but neither foot rose to the level of “moderate,” for any rating higher than the 0% for each foot assigned by both the PEB and VA.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral foot pain.  

BOARD FINDINGS:  In the matter of the bilateral foot pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150624, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01934.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings