RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “bilateral foot pain” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20050810	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5099-5022	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  The PEB combined the right and left foot conditions as a single unfitting condition coded 5099-5022 (periostitis), rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, 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 referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left foot conditions are presented together, with attendant recommendations regarding separate unfitness and rating in the rating discussion.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began in April 2005 with gradual onset of right foot pain, about 2 weeks into basic training.  The left foot pain began about 1 week later.  The right foot X-rays were negative, but the pain persisted.  A bone scan was done on 9 May 2005 and identified bilateral stress fractures (repetitive stress induced fractures) to include left calcaneus, bases of the first and second metatarsals, focally along the base of the right fifth metatarsal and focally within the expected location of the bilateral cuboid bones.   Bilateral foot X-rays on 16 June 2005 showed no radiographic evidence of stress fracture.  

During the 20 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported bilateral foot pain.  Physical examination showed mild tenderness with calcaneus squeeze, no metatarsal tenderness and normal arches.  The 26 July 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of bilateral foot pain that averaged 5-6/10 and up to 8/10 with prolonged walking.  Physical examination showed a tandem gait that was not antalgic (assuming a gait or posture to lessen pain).  The bilateral lower extremity examination revealed a normal ankle examination, no localized tenderness and full range of motion (ROM).  The examiner’s notes stated, “Right foot localized tenderness to the medial and lateral aspect of the calcaneus with squeeze.  There is no tenderness to the mid‑anterior foot including metatarsals.  Left foot localized tenderness with lateral squeeze of the calcaneus.  There is no tenderness to the mid-anterior foot.”  There was no swelling or edema (excess tissue fluid swelling).  Strength and sensation were normal.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain 0%, coded 5099-5022 (periostitis), citing full ROM and strength of both feet and ankles, with tenderness of the left foot.  As previously elaborated, the panel must first consider whether the right and left foot conditions remain separately unfitting, having been de-coupled from a combined PEB adjudication.  In this case, both feet were considered to fail retention standards.  Both feet were implicated in the NARSUM and both feet were profiled.  STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either foot over the other. The physical demand rating for her job is very heavy.  The panel agreed that each foot was reasonably justified as separately unfitting.  The most current X-rays showed no evidence of stress fractures.  The CI had a normal gait and full ROM of both ankles and no localized tenderness and no swelling or edema.  There was localized tenderness with squeeze of each calcaneus.  There was no weakness for consideration under 5277 (weak foot).  There was no evidence of sensory pathology for consideration under 5279 (metatarsalgia).  There was no deformity for consideration under 5276 code (flatfoot, acquired), 5278 (claw foot), 5280 (hallux valgus) 5281 (hallux rigidus), 5282 (hammer toe), or 5283 (metatarsal bones malunion/nonunion of).  The panel agreed a 10% rating was not supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not more nearly approximate “moderate” to support the next higher 10% rating under this code.  The panel concluded that the evidence did not provide sufficient grounds for recommending separate disability ratings in this case, and that the combined rating of 0%, coded 5099-5022, is a good analogy to both the pathology and disability.  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 condition.  

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 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 20150805, w/atchs
Exhibit B.  Service Treatment Record

AR20170010052, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,