RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02333
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Wheeled Vehicle Mechanic, medically separated for “bilateral pronated foot deformity with posterior tibial dysfunction and acquired clinical flat feet” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 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 – 20070209	VARD - 20080311	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Pronated Foot Deformity with Posterior Tibial Dysfunction and Acquired Clinical Flat Feet	5299-5276	10%	Left Foot Osteochondritis Dessicans of Talar Head	5009-5284	10%	20071213	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Pronated Foot Deformity with Poster Tibial Dysfunction and Acquired Clinical Flat Feet.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced left foot pain one month into basic training without specific injury.  Left foot X-rays on 31 October 2005 revealed evidence of a fused accessory navicular which was possibly associated with the pain.  A bone scan showed no evidence of a stress fracture, but a left foot MRI in February 2006 showed changes of the talar head and cuneiform consistent with osteoarthritis, or less likely, osteochondritis dissecans.  The CI was evaluated by a podiatrist at an outside medical facility with no specific diagnosis rendered.  

During the 3 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic left foot pain, a collapsed arch, and “crunching noise.”  He stated that he walked with a limp, had left foot weakness, and could not run, jump, or do sit-ups/push-ups or calf raises.  He wore a removable brace and shoe inserts, but these did not provide relief.  The examiner noted the CI used a controlled ankle movement (CAM) walker during the day and the removable brace (Aircast) at night on the left foot, but had no problems with the right foot.   Physical findings revealed pes planus (non-specific) and tenderness along the top of the left foot.  The 8 December 2006 MEB NARSUM examination, 4 months before separation, noted complaints of left foot pain at rest that increased with standing or walking.  The CI was still using a CAM walker throughout the day, and took anti-inflammatory medication several times a week for pain.  Physical examination showed an antalgic gait, bilateral foot pronation (greater on the left), and heels aligned in minimal valgus.  He had a positive “too many toes sign” bilaterally (consistent with posterior tibial dysfunction) and was able to do a normal heel raise on the right, but not on the left.  Leg strength was normal and calf circumference was 28.5 cm on the left, compared to 29 cm on the right.  He was “somewhat sore” over the left dorsolateral foot, but there was no swelling or abnormal callus formation.  Ankle range of motion (ROM), after repetition, showed bilateral ankle dorsiflexion to 24 degrees (normal 20) and plantar flexion to 45 degrees (normal).  

At the 13 December 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported left foot pain and an audible “crunching” when he walked without shoes.  He also noted the left foot was flatter than the right foot, which had no symptoms.  His pain was primarily located on the top and lateral left mid-foot near the head of the talus bone with weekly flare-ups exacerbated by activity and lasting 1-2 days.  He denied swelling or stiffness, but endorsed pain, redness, weakness, lack of endurance and use of an Aircast.  Physical examination showed a limp, tenderness without swelling, and mild atrophy of the bottom of the left foot, which had a flatter arch when standing.  Pain was noted in all planes of left foot motion along with guarding, but there were no other deformities, and right foot findings were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 10%, analogously coded 5299-5276 (flatfoot, acquired), citing bilateral flat feet with pronation and a symptomatic left foot with some pain limited ROM.  The VA rated the left foot condition 10%, analogously coded 5099-5284 (foot injuries, other), based on the C&P examination, citing moderate symptoms; and did not rate or address a right foot condition.  Panel members first considered whether the left or right foot conditions were reasonably considered separately unfitting.  The left foot was profiled and the bilateral foot condition failed retention standards.  The commander’s statement did not specifically identify the CI’s medical conditions or address duty performance, but the CI reported left foot pain and received treatment for only this foot during service.  The panel agreed the left foot was reasonably considered separately unfitting, but there was a preponderance of evidence that the right foot was not unfitting when considered on its own.  

The panel then considered a rating recommendation for the unfitting left foot, and the panel majority agreed that a 10% rating was supported for moderate acquired flatfoot, but that there was no evidence of severe flatfoot with marked deformity, swelling or characteristic callosities for a higher rating under code 5276.  The panel majority also considered a rating under code 5284, but adjudged that the evidence did not support characterizing the CI’s injury as moderately severe for a higher 20% rating based on the MEB NARSUM and VA examination findings, which noted tenderness, painful motion and use of a brace, but no swelling, other foot abnormalities, or required assistive devices for ambulation.  The panel majority also noted that a 10% rating for the bilateral feet, coded 5299-5276 is a VASRD compliant rating.  Panel members considered other VASRD foot and analogous codes but all were less applicable and/or not advantageous for rating.  Having unbundled the bilateral feet, the panel majority’s fitness and rating recommendations provided no ratings benefit to the CI, and thus, after due deliberation, considering all the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral foot condition. 

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20%, coded 5284 and did not elect to submit a minority opinion.  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 20170407, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 
PD-2017-02333

AR20200000622, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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

PD-2017-02333