RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01565
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Management Craftsman, medically separated for “congenital foot deformity--pes planus” with a 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 - 20080414	VARD - 20090109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Congenital Foot Deformity--Pes Planus	5276	20%	Bilateral Pes Planus	5276	10%	20080815	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Congenital Foot Deformity--Pes Planus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was noted to have a right talocalcaneal coalition (an abnormal connection between two ankle bones) in 1999.  This was initially treated with medications and shoe inserts, but then resected on 10 January 2001.  Despite initial symptom improvement, she had progressive pain and decreased right foot range of motion (ROM) in early 2005.  She was also noted to have bilateral flat feet (pes planus), and bilateral foot X-rays showed degenerative changes.  

At the 27 February 2006 MEB NARSUM examination, 3 months prior to separation, the CI reported a history of pain for at least 8 years which was aggravated by physical activity.  She wore comfort shoes and orthotics, but still had persistent pain.  She was also noted to have rheumatoid arthritis which was responding to treatment.  Physical examination showed an antalgic gait, bilateral flat feet, and reduced right ankle ROM compared with the left.  In family practice on 16 June 2008, 3 weeks after separation, the CI had a normal gait and bilateral ankle motion.  She was seen in orthopedics 1 month later and noted to have 10 degrees of dorsiflexion (normal 20) and 35 degrees of plantar flexion (normal 45) on the right with no measurements recorded for the left ankle.  Gait was slightly antalgic and the examiner recommended activities as tolerated and a semi-sedentary occupation.  

The 15 August 2008 VA Compensation and Pension (C&P) evaluation, 3 months after separation, noted CI complaints of ongoing, right greater than left, foot pain aggravated by activity.  On examination, gait was normal with bilateral dorsiflexion to 18 degrees and plantar flexion to 45 degrees, bilaterally.  Tenderness was present in both ankles, which were stable and without angulation.   Ankle X-rays showed a bony spur on the left and evidence of the coalition on the right.  During the 19 November 2008 C&P joint evaluation, 6 months after separation, the CI reported bilateral lower extremity swelling.  The examiner documented normal gait and posture with no use of an assistive device.  Measured ROM was 10 degrees dorsiflexion and 35 degrees plantar flexion, limited by soft tissue edema rather than joint pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right pes planus conditions 10% each, coded 5276 (pes planus).  The VA rated the bilateral pes planus condition 10%, also coded 5276, based on the C&P evaluation, citing pain with manipulation.  Members noted that the majority of examinations documented a normal or near normal gait and ROM which warranted a 10% rating under code 5276 “for pain on manipulation and use of the feet (unilateral or bilateral condition).”  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 left and right pes planus condition.  

BOARD FINDINGS:  In the matter of the left and right pes planus conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01565.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings