RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03262 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070713

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Corpsman (Instructor), medically separated for “flexible flatfoot deformity” with a 10% disability rating.

CI CONTENTION: Review requested of an additional condition (osteoarthritis), not identified by the Medical Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070508	VARD - 20071009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Flexible Flatfoot Deformity	5299-5003	10%	Bilateral Pes Planus with Acquired Pronation	5276	0%	20071228	
Bilateral Pronation	Cat II					
Clinical Bunion	Cat II	Right Hallux Valgus with Neuroma	5280	0%	20071228	
		Left Hallux Valgus with Neuroma	5280	0%	20071228	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Flexible Flatfoot Deformity. The PEB combined the bilateral foot condition under a single disability rating, coded 5003 (arthritis, degenerative) and rated 10%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating

requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began approximately 2.5 years before she entered the medical boarding process. In August 2006, she reported increased pain in the left great toe with swelling and numbness, and subsequently reported the same symptoms of the right foot. She was evaluated by podiatry in October 2006 for bilateral foot pain not improved by treatment, and was prescribed orthotics for flexible flatfoot with pronation. Foot X-rays on 14 February 2007 showed bilateral cortical thickening of the third and fourth metatarsals, which was interpreted as “probable stress reaction.” No surgery was indicated.

The 15 February 2007 MEB NARSUM examination, 5 months prior to separation, was accomplished by a podiatrist, and noted CI complaints of bilateral foot pain and intermittent numbness on the bottom of the feet, worse on the left, and at the end of the day. Physical examination showed a normal gait and lower extremity strength, sensation, and reflexes. The examiner noted “a flexible flatfoot deformity upon walking” and “intermittent paresthesias in her feet,” with extensor hallucis longus tendons (great toe dorsiflexion) tenderness, but no crepitus of either toe. There was also pain with plantar flexion, mainly on top of the first metatarsophalangeal (MTP) joints, and greater than 10 degrees of ankle dorsiflexion bilaterally, without painful motion. A clinical prominence was found along the first metatarsal head, but there was no X-ray evidence of hallux valgus of either foot.

At the 28 December 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported being diagnosed with pes planus, and that while walking or standing could be impossible due to the foot pain, she could sometimes function with medication. Physical examination showed a normal gait and no evidence of abnormal weight bearing on either foot. There was painful motion of both feet, but no tenderness, swelling, weakness, or muscle atrophy. The examiner noted no foot or toe deformities, “active motion” in each of the great toe MTP joints, and pain relief with wearing corrective shoes. Bilateral ankle ROM was normal, with painful motion but no additional loss of motion after repetition. Foot X-rays, with and without weight bearing, showed a pes planus deformity of both feet.

The panel first considered whether either foot condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The bilateral foot conditions were noted on limited duty forms, implicated in the non-medical assessment (NMA), and failed retention standards, but panel members agreed the NMA and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either foot over the other. Since undue speculation would be required to conclude that impairment from either foot would not have unacceptably interfered with the performance of military duties, the panel agreed that each foot was reasonably justified as separately unfitting.

The panel directed attention to its rating recommendations based on the above evidence. As noted above, the PEB rated the bilateral foot condition 10%, analogously coded 5299-5003, and listed “bilateral pronation” and “clinical bunion” as related conditions (Category II) contributing to the unfitting disability. Panel members concluded these diagnoses could not be reasonably

justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the bilateral foot condition 0%, coded 5276 (acquired flatfoot), based on the C&P examination, citing mild symptoms relieved by built- up shoe or arch support. Panel members noted the objective findings and associated disability for each foot were nearly identical, and agreed the respective ratings should therefore be the same. A single 10% rating, coded analogous to 5276, was supported for bilateral pes planus, with painful motion of the feet noted at both the MEB NARSUM and VA examinations. However, a 10% rating under code 5279 (metatarsalgia) for each foot was supported for pain of the first MTP joints of each foot documented at the MEB NARSUM examination. A 10% rating was alternatively supported for painful motion of the bilateral ankles after repetition recorded at the C&P examination. The panel considered other VASRD ankle and foot codes, but all were less applicable or advantageous for rating. There was no higher rating than 10% supported for either foot with any applicable VASRD code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends disability ratings of 10% each, for the right and left foot conditions, both coded 5279.

BOARD FINDINGS: In the matter of the bilateral foot condition, the panel recommends that each joint be separately adjudicated as follows: an unfitting right flexible flatfoot deformity, coded 5279 and rated 10%; and an unfitting left flexible flatfoot deformity condition, coded 5279 and rated 10%, both IAW VASRD §4.71a. 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 Flexible Flatfoot Deformity	5279	10%	
Left Flexible Flatfoot Deformity	5279	10%	
	COMBINED	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.