RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03809
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20050830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E4, Air Traffic Control Apprentice, medically separated for “bilateral flat feet,” rated 10% for each foot, with a combined disability rating of 20%.   

CI CONTENTION:  Service aggravation of the foot conditions should have resulted in medical retirement.  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 - 20060403	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Flat Feet	5276-5299	10%	No VA Examination in Evidence	
		10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Flat Feet.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right foot surgery in October 2003 with posterior calcaneal osteotomy and Evan’s procedure with bone graft to increase the arch.  By January 2004 the surgery had healed without any pain or complicatons and inserts worked well.  The CI underwent a similar surgery on the left foot in April 2004.  Post-operative X-rays showed integration of the bone graft and the osteotomy site, and fixation was well-aligned and intact.  The surgical pin was removed.  Podiatry noted the CI was doing much better in March 2005 and was able to stand for prolonged periods of time without pain or problems; however, with running and ballistic type of activity, he still had pain and tenderness in the medial arch region.  X-rays showed good bone consolidation and the corrections were well-maintained.  He tolerated his inserts well, but even with them, his feet became painful with running or ballistic activity.  During the 14 April 2004 MEB NARSUM examination, 5 months prior to separation, the CI reported bilateral foot pain.  Physical examination showed  no cyanosis, clubbing or edema of the extremities.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left foot conditions 10% each, analogously coded 5276-5299 (flat foot, acquired), citing improvement, but pain on vigorous physical activity which existed prior to service but was service aggravated.  A moderate disability rating under code 5276 requires evidence of “weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet.”  A rating of 10% is assigned for either a bilateral or unilateral disability.  There was insufficient evidence in the STR to show that a rating higher than 10% was warranted for a severe disability, which requires “objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation, and use accentuated, indication of swelling on use, characteristic callosities” nor was there evidence to support a rating for a pronounced disability, which requires “marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances.”  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 left and right foot conditions.  

BOARD FINDINGS:  In the matter of the bilateral flat feet condition and IAW VASRD §471a, the panel recommends no change in the PEB adjudication.  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:

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03809.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.