RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01661
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic low back pain” and “symptomatic pes planus,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

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 - 20050613	VARD - 20060118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease of Lumbar Spine…	5243-5237	10%	20050920	
Symptomatic Pes Planus	5099-5003	0%	Pes Planus and Plantar Fasciitis	5399-5276	10%	20050920	
Bilateral Plantar Fasciitis..	Not Unfitting					
Right Greater Trochanteric Bursitis	Not Unfitting	Right Hip Trochanteric Bursitis…	5019	10%	20050920	
Severe Obstructive Sleep Apnea	Not Unfitting	Chronic Obstructive Sleep Apnea	6847	50%	20050920	
Dysthymic Disorder	Not Unfitting	Dysthymic Disorder	9433	30%	20050920	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Lower Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP condition began in 2003 after a training accident.  During the 15 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, there was lumbosacral paraspinal tenderness and decreased range of motion (ROM).  Muscles spasm was not present.  

The 22 December 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of LBP which increased with activity.  Physical examination showed lumbar paraspinal tenderness with mechanical limitation of motion in most planes.  Thoracolumbar ROM was forward flexion to 78 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  The gait was normal and there was no muscle spasm.

At the 20 September 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily, 5/10, sharp, stabbing LBP which increased to 6/10 with physical activity.  The CI reported being able to function without pain medication.  Physical examination showed normal gait. Thoracolumbar forward flexion and combined ROM were normal but with painful motion.  There was tenderness over the sacral base and sacroiliac joints but no muscle spasm.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing mechanical limitation of flexion to 80 degrees and paraspinous muscle tenderness.  The VA also rated the condition 10%, coded 5243-5237 (intervertebral disc syndrome-lumbosacral strain), based on the C&P examination, citing painful motion and limitation of activities.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination, and for painful motion as reported on the VA examination. There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation incapacitating episodes secondary to of intervertebral disc syndrome which would provide for a higher rating under that formula.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all 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 LBP condition.  

Symptomatic Pes Planus. According to the STR and MEB NARSUM, the CI’s bilateral foot pain condition began in 2004.  The CI was treated with physical therapy.  At the 1 November 2004 primary care evaluation the CI reported bilateral, 6/10 foot pain which was greater on the right and increased with prolonged standing and walking.  Physical examination showed bilateral pes planus (flatfoot).   The gait was normal.  

The 22 December 2004 MEB NARSUM physical examination showed bilateral plantar fascia, medial and posterior heel, and ankle tenderness.  There was hyperpronation of the feet.  The 28 February 2005 radiographic evaluation demonstrated bilateral pes planus, a left heel spur, and bilateral medial deviation of the distal interphalangeal joints of the fourth and fifth toes.  

During the 2 March 2005 podiatric evaluation the CI reported bilateral foot pain.  The pain was worse with a 2-month trial of orthotics, but decreased with the use of Saucony (stability) shoes.  Physical examination showed pain to palpation of the medial band of the plantar fascia bilaterally.  

The 3 May 2005 podiatric physical examination showed flexible pes planus.  The examiner also noted seeing more toes as a result of a mild foot deformity related to flatfeet.  There was pain with inversion of the right foot against resistance.  

At the 20 September 2005 C&P evaluation the CI reported bilateral pain with repetitive motion.  Physical examination showed a normal gait.  There was pes planus without deformity of the feet.  There was moderate tenderness of the right distal fibula.  The examiner noted the CI did not use corrective shoes. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the pes planus condition “IAW 10 USC 1207a (eight-year rule)” and rated the condition 0%, analogously coded as 5003 (degenerative arthritis), citing pain that was slight and occasional.  The VA rated the condition 10%, coded analogously as 5276 (flatfoot, acquired), based on the C&P examination, citing pain on manipulation and use.  

The panel agreed that a 10% rating, but no higher, was justified for pain on manipulation and use of feet as noted on the podiatric, NARSUM and VA examinations.  There was no evidence of marked deformity (pronation, abduction, etc.), accentuated pain on manipulation and use, swelling on use, and characteristic callosities for a 30% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the symptomatic bilateral pes planus condition, coded 5276.  

Contended PEB Conditions:  Severe Obstructive Sleep Apnea, Right Greater Trochanteric Bursitis, Bilateral Plantar Fasciitis, and Dysthymic Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions, except for sleep apnea were profiled or judged to fail retention standards. None of the conditions were implicated in the commander’s statement.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the symptomatic bilateral pes planus condition, the panel recommends a disability rating of 10%, coded 5276 IAW VASRD §4.71a.  In the matter of the contended severe obstructive sleep apnea, right greater trochanteric bursitis, bilateral plantar fasciitis, and dysthymic disorder conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration 

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5237	10%	
Bilateral Pes Planus	5276	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170304, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010938, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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