RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2017-02290
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050201

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve, Finance Officer, medically separated for “right ankle pain” with a disability rating of 10%. “Pes planus” was determined to have existed prior to service (EPTS) and was not rated.

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 - 20041209	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271	10%	No VA Examination Proximate to Separation in Evidence	
Pes Planus	5276	EPTS		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Right Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgical intervention to the right ankle and heel in December 2003 which revealed a significant amount of scar tissue surrounding the ankle joint. The 1 October 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right ankle pain. The physical examination (PE) revealed the wear of an ankle brace and removable cast boot on the right foot which caused him to limp. There was slight swelling and tenderness about the right ankle.  Right ankle range of motion (ROM) was markedly decreased and painful.     Physical

therapy measured dorsiflexion of 1 degree (normal 20) and plantar flexion of 34 degrees (normal 45). There was no VA Compensation and Pension (C&P) examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 10%, coded 5271 (limited motion of ankle), citing decreased ROM due to pain. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority agreed the limitation of motion was considered “marked” instead of moderate and recommends a disability rating of 20%, coded 5271.

Pes Planus. The PEB determined the pes planus existed prior to service and was not permanently service aggravated beyond natural progression; however, the case file contained a specialty PE for airborne school that was performed on 24 July 2002, 7 months after enlistment, which revealed normal and asymptomatic arches of both feet. The panel noted that a presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service. Since the completion of the airborne school specialty examination, the STR contained various physical therapy and podiatry encounters that either noted pes planus as a diagnosis or simply noted having symptoms of the same without a documented diagnosis. During the second half of 2003, there were few clinical encounters that documented evidence of pes planus. The vast majority of the STRs were attributed to the right ankle condition as previously discussed above. X-ray impressions revealed verbiage as “low arch morphology” and not actually pes planus. Additionally, the surgical report described the CI as having “a low arch morphology on and off weight bearing.”

A podiatry encounter on 29 April 2004, 9 months prior to separation, noted the CI had custom orthotics and stated “he gets much relief of plantar arch discomfort.” Three weeks later, podiatry documented that the CI had symptoms of pes planus “improved with custom inserts.” The same encounter did not list pes planus as a diagnosis. The 24 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, noted complaints of painful walking and physical findings of prominent bilateral pes planus and “tenderness in both mid-plantar area.”  The diagnosis remained as symptomatic bilateral pes planus.

Panel members first deliberated if the pes planus was a unilateral or bilateral condition. Pursuant to the MEB’s PE noting the diagnosis under the heading of “Feet” coupled with comments regarding weight bearing as well as the diagnosis on the DD Form 2808, members agreed that the condition was indeed bilateral. After an extensive review, the panel agreed that the inconsistencies and fleeting diagnosis of pes planus, with minimal or improved symptoms in both feet, supports a finding of no permanent service aggravation and the panel recommends no change in the PEB’s adjudication.

BOARD FINDINGS: In the matter of the right ankle condition, the panel majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a. The single voter for dissent recommends no change but does not elect to submit a minority opinion. In the matter of the pes planus condition 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.

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

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5271	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170301, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007569, 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