RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02253
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “bilateral foot pain” with a disability rating of 0%.  

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 - 20080325	VARD - 20090820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5278-5399-5312	0%	Pes Cavus w/Associated Plantar Fasciitis, Bilateral Feet	5278	0%	STR	
		0%					
Bilateral Carpal Tunnel Syndrome (CTS)	Not Unfitting	Residuals of CTS Release, Right 	8515	0%	STR	
		Residuals of CTS Release, Left 	8515	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported that her bilateral foot condition began during her military occupational specialty training as a food service specialist due to the requirement to be on her feet for long hours.  The first record in evidence for the right foot was an X-ray request for the right foot which noted toe joints pain (metatarsal heads).  The X-rays were normal.  She was issued orthotics, but her pain persisted.  She was diagnosed in podiatry with bilateral pes cavus (high arches) and plantar fasciitis on 22 May 2007, 12 months prior to separation.  The gait was normal and the range of motion (ROM) of both feet and ankles was normal but motion of the feet was painful.  At a follow-up in podiatry on 16 July 2007, the examination of the ankles and feet was unchanged.  

During the 1 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 11 months prior to separation, the CI reported high arches.  Physical examination showed normal feet and lower extremities other than moderate, symptomatic pes cavus.  X-rays of both feet were normal but for the high arches.  

In physical therapy on 27 November 2007, dorsiflexion (toes up) of the right ankle was 15/15/20 (normal 20) and the left showed 15/15/15.  Plantar flexion (toes down) was normal bilaterally at 45 degrees for all three repetitions.  No abnormal limitation in motion was noted and the CI could heel and toe walk.  

The 7 December 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of bilateral foot pain with standing and walking.  The ROM measurements from the physical therapy evaluation were cited.  It was noted that the strength and stability of the ankles were intact.  

At an appointment on 18 March 2018, following a toe nail ablation, the gait and stance were normal as they were at a follow-on examination 2 days later.  At both examinations, the CI denied left, ankle, and foot pain.  The examinations of the feet and ankles were normal.  There was no VA examination proximate to separation in evidence as the CI failed to report for her Compensation and Pension (C&P) examination.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each foot condition 0%, dual and analogously coded 5278-5399-5312 (claw foot, pes cavus, acquired/foot and leg group XII function), citing the condition was “slight.”  The VA also rated the bilateral foot condition 0%, coded 5278, based on the STR, citing that a non-compensable rating is granted whenever there are only slight symptoms of clawfoot.  The panel noted that this rating was continued on a subsequent rating decision following a post-separation C&P examination.  

The panel noted that the CI was found to have a normal gait on multiple examinations and also normal ROM on all examinations except the left foot dorsiflexion measured in physical therapy.  She was noted to be tender over the metatarsal heads when examined in in podiatry, but this was 10 months prior to separation.  The examinations closest to separation noted normal examinations of the feet and ankles and the CI was pain-free (other than the toe nail ablation).   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 bilateral foot condition.  

Contended PEB Condition:  Bilateral Carpal Tunnel Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement.  It was judged to meet retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral carpal tunnel syndrome, the panel recommends no change from the PEB determination 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015069, 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.

A copy of this decision has been provided to the counsel you listed on your application, AMVETS Regional Office, 1240 East 9th Street, #1017, Cleveland, OH 44199-9904.

Sincerely,					       

Enclosure