RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00982
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Signal Support System Specialist, medically separated for “painful calluses on both feet” with a combined disability rating of 20%.

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20080312	VARD - 20080814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Calluses on Both Feet… (Each foot rated 10%)	5299-5276
7899-7804	20%	Plantar Fasciitis and Surgical Excision of Calluses, Right Foot	5284	0%	20080403	
			Plantar Fasciitis and Surgical Excision of Calluses, Left Foot	5284	0%	20080403	
Anxiety Disorder	Not Unfitting	Adjustment Disorder…	9440	30%	20080329	
Non-Organic Sleep Disorder	Not Unfitting					
Acne	Not Unfitting	Acne	7828	0%	20080403	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Painful Calluses, Both Feet.  According to service treatment record and the MEB narrative summary (NARSUM), the CI was initially seen for a bilateral painful foot condition in April 2007 following a deployment the previous year.  He was referred to podiatry and evaluated on 23 May 2007.  He was noted to have bilateral hammer toes and bunions.  Callus formation was also noted and minor surgery to debride (shaved) the callus formations was performed during this same appointment.  He healed well clinically, but had persistent pain despite profiling, the use of a cane, and physical therapy.  He was not able to return to full duty.

The MEB DD Form 2808 dated 30 November 2007, noted bilateral callus formation over the great toes and second metatarsals which were tender to palpation.  The CI was also noted to have mild, symptomatic pes planus (flat feet) and bilateral bunions.  The panel observed that the pes planus condition had not been diagnosed by multiple podiatry and physical therapy encounters nor at the MEB NARSUM examination which was accomplished by podiatry.

The 15 January 2008 MEB NARSUM examination, 5 months prior to separation, noted persistent pain.  Physical examination showed calluses over the balls of both feet.  There was pain with manipulation, but the range of motion and motor function were normal.  X-rays showed a decreased medial arch bilaterally (flat feet), but were unremarkable otherwise.  He used a cane and was unable to stand greater than 10 minutes or walk greater than half mile.  

At the 3 April 2008 VA Compensation and Pension (C&P) General evaluation, 3 months before separation, the CI reported the use of a cane.  Limitations from the feet were not recorded, but the CI stated that his neck and back flared if he stood over 30 minutes or walked over one mile.  Physical examination showed well healed surgical scars.  Motion of the great toe was limited and painful.  Pes planus was not recorded as present on examination.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each foot at 10% for the painful bilateral callus condition, analogous coded 5299-5276 (flatfoot, acquired) and code 7899-7804 (scars, superficial, painful on examination), citing the CI’s inability to stand greater than 30 minutes or walk greater than half mile, for a combined disability rating of 20% for both feet with application of the bilateral factor.  The PEB also noted that pes planus commonly underlies the callus condition.  The VA rated the painful bilateral callus condition 0% for each foot, coded 5284 (foot injuries, other), based on the C&P General examination, citing the absence of moderate symptoms associated with foot injury.

The CI had multiple calluses on both feet.  A callus is an area of thickened, hardened skin which forms in response to repetitive friction and decreases or resolves when the repetitive trauma is curtailed.  A scar, however, is a permanent reaction to an injury of the skin and underlying tissue with remodeling of the underlying tissue.  Accordingly, the panel determined that code 7804 was not consistent with the unfitting pathology at separation.  The panel noted while the examiner for the DD Form 2808 noted mild pes planus and the PEB cited this diagnosis; however, this pes planus was not diagnosed by podiatrists, physical therapists, nor VA examiner.  The panel determined that if present, pes planus would not rise to a compensable impairment under the code 5276.  The panel also noted that only one 10% rating (10% level of impairment) can be rendered under code 5276 for either bilateral or unilateral foot impairments IAW the VASRD.  The panel agreed code 5282 (hammer toes) would support a 10% rating for each foot, although this was noted clinically, this condition was not cited by either the MEB or PEB as a diagnosis.  The panel then considered code 5284 and determined that it best fit the underlying pathology.  The CI was able to walk a half mile at the time of the MEB NARSUM and a full mile by the VA examination.  This is most consistent with a moderate impairment at separation which supported a 10% rating for each foot.  This provided no rating advantage to the CI.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral painful callus condition.

Contended PEB Conditions: Anxiety Disorder, Acne, and Nonorganic Sleep Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement.  All were judged to meet retention standards.  There was no performance-based evidence from the record that any of the contented conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the painful bilateral callus condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder, acne, and nonorganic sleep disorder conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005219, 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,					      
Enclosure