RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01147
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “bilateral symptomatic pes planus” with a disability rating of 0%.  

CI CONTENTION:  “Higher rating from VA…wrongly stated in DA3947 conditions existed prior to service.”  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 - 20040204	VARD - 20040914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Symptomatic Pes Planus	5003	0%	Bilateral Pes Planus	5276	30%	20040525	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Bilateral Symptomatic Pes Planus.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s congenital bilateral pes planus (flat foot) was noted as mild on his April 1996 service entry physical.  Over the next few years, he became more symptomatic without injury.  Radiographic imaging showed no foot fracture or abnormal sclerosis.  He was initially treated with orthotics and duty limitations, but his symptoms continued to progress.  Left foot weight bearing X-rays on 8 April 2003 confirmed the presence of pes planus.  On 30 September 2003, an orthopedist documented pes planus with hind foot valgus for which orthotics had been minimally successful.  Repeat X-rays on 4 December 2003 confirmed the presence of bilateral pes planus.  
The 10 January 2004 MEB NARSUM examination, 2 months prior to separation, recorded progressive symptoms since 1999 without improvement from orthotics and physical therapy.  The CI stated that these were present 80% of the time.  The examiner noted severe pes planus with pronation and tenderness of the sole of the foot (plantar surface) and rated the pain as “slight and constant.” 

At the VA Compensation and Pension (C&P) foot, joint, and general evaluations, all performed on 25 May 2004, 2 months after separation, the CI complained of ongoing pain despite treatment.  He reported benefit from not being on his feet and from the use of custom orthotics, but standing was limited to 2-3 hours.  In podiatry, he was noted to have a wide-based, but non-painful gait.  Physical examination showed mild tenderness bilaterally with a bowed Achilles tendon.  There was no swelling and range of motion was normal.  Evidence of abnormal weight bearing was not present and bilateral pes planus was clinically apparent.  The joint and general examinations both showed a normal gait.  Ankle X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral pes planus condition 0%, analogously coded 5299-5276 (flatfoot, acquired), citing “slight.”  The VA rated the bilateral pes planus condition 30%, coded 5276, based on the C&P examination 2 months after separation, citing severe bilateral pes planus as recorded in the STR.  The panel considered the evidence, noting the CI’s congenital pes planus was documented on the accession examination, but permanent service-aggravation was determined by the PEB.  No deduction for the existed prior to service (EPTS) contribution was taken. The panel did not find a diagnostic code more applicable than 5276, which was used by both the PEB and VA.  A moderate level of impairment, which supports a 10% rating, is warranted from pain on manipulation and use, inward bowing of the Achilles tendon, and with the weight bearing line over or medial to the great toe(s).  The first two symptoms were documented by the C&P examiner but there was no evidence of abnormal weight bearing recorded.  The panel noted that the 10% rating is for a unilateral or bilateral condition.  A higher 30% rating, as adjudicated by the VA, is a severe condition with evidence of a marked deformity, swelling on use, and characteristic callouses.  These were absent, and moreover, the gait was noted to be normal by two examiners and wide (but not painful) by a third, all in the same day.  The evidence does not support a finding of a severe impairment at separation.  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 condition, coded 5276.   

BOARD FINDINGS:  In the matter of the bilateral symptomatic pes planus condition, the panel unanimously recommends a disability rating of 10% for the bilateral pes planus condition, coded 5276 IAW VASRD §4.71a.  There are 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	5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160924, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170018883, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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