RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03973
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050615

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4 , Organizational Automotive Mechanic, medically separated for “symptomatic pes cavus, bilateral” with a disability rating of 20%.

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’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 - 20050407	VARD - 20060526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Symptomatic Pes Cavus, Bilateral	5278	20%	Bilateral Pes Cavus	5278	40%	20060526	
Soft Tissue Masses, Bilateral Feet	Cat II	No VA Placement	
Osseus Equinus, Bilateral	Cat II	No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Bilateral Symptomatic Pes Cavus. The PEB combined the left and right foot pes cavus (high arch) as a single unfitting condition, coded 5278 (claw foot (pes planus), acquired) and determined that it existed prior to service (EPTS), and was permanently service aggravated (SA) with a 50% disability rating and a 30% EPTS deduction for a final 20% rating. 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’s initial charge in this case was therefore directed at determining if the PEB’s approach of 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. The evidence for the bilateral pes cavus is presented together.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral pes cavus was congenital, and he was evaluated by sports medicine on 22 October 2001 prior to seeking enlistment in the Marine Corps. At the examination, he reported a history of high arches (like his mother), but no clawtoes (similar to hammertoes), pain, or paresthesia in the feet. He occasionally had midfoot pain after walking for long periods without good arch support, but was not restricted from any activities. He had not worn any orthotic arch supports in the past. Physical examination showed bilateral cavus feet, with hindfoot valgus on the left. Ankle dorsiflexion (DF) was to 0 degrees (normal 20) with tight heel cords. There was no clawtoe deformity and foot range of motion (ROM) was pain-free with normal strength. There was no tenderness of the feet or Achilles tendons, and he was able to heel and toe walk without difficulty. The examiner noted moderate, bilateral asymptomatic pes cavus, and that the CI had always been asymptomatic, could wear any type of foot gear, and was very physically active.

While on active duty, podiatry examinations in the STR noted dorsal soft tissue masses on both feet, with one felt to be a hypertrophied tendon, and the other an anomalous muscle. There was no ankle dorsiflexion and bilateral foot X-rays in July 2004 showed hyperostosis (bony deformity) of the talar neck causing osseous ankle equinus in both feet (bony restriction of ankle DF).

The 28 February 2005 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of chronic painful symptoms on the top of the feet. The examiner documented that he was able to ambulate comfortably in specially molded boots with custom inserts, but was unable to tolerate “the up tempo” of the Marine Corps. Physical examinations showed a nearly rigid pes cavus foot type with bony blockade of ankle dorsiflexion bilaterally. Both feet had diffuse sub-metatarsal callosities and subcutaneous soft tissue masses.

The 9 March 2005 non-medical assessment (NMA), 3 months before separation, indicated that due to the CI’s physical limitations he was unable to successfully perform all duties required of a Marine, including prolonged standing and physical training. The 28 April 2004 limited duty form listed pes cavus and dorsal soft tissue masses of both feet.

At the 13 May 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain, weakness, stiffness, and fatigue at rest and also while standing and walking. He wore orthotics to align the heels and support the high arches. Physical examination showed extremely high arches in both feet and painful bilateral ankle motion, but no evidence of abnormal weight bearing. There was tenderness of both arches and Achilles tendons, but none along the metatarsal heads. The examiner noted no pain with toe dorsiflexion, a well-aligned Achilles tendon, and no evidence of hammertoes, metatarsalgia, or hallux rigidus. Ankle ROM was normal bilaterally without pain, fatigue, weakness, lack of endurance or incoordination. Foot X-rays showed bilateral hallux valgus.

At the 2 May 2006 VA C&P examination, 11 months after separation, the CI reported pain and stiffness of both feet at rest, with additional weakness while walking. He had intermittent bilateral foot pain as often as 5 times per week for 2 hours or more at a time, and was not able to stand, walk or run for prolonged periods. However, he denied any lost time from work. Physical examination showed a normal gait and posture, with good Achilles tendon alignment but marked pronation of the feet. There were callosities of the bilateral heels and metatarsophalangeal joints throughout all toes on the soles of the feet. The examiner noted pes

cavus, contraction and shortening of the plantar fascia, plantar surface tenderness, dropped forefoot and marked varus deformity of both feet, but no painful motion. Toe dorsiflexion produced no pain and there was no metatarsal head tenderness, hammertoes or metatarsalgia. There was slight hallux valgus bilaterally but no hallux rigidus. Left foot X-rays showed mild hallux valgus and pes cavus.

The panel first considered whether each of the right and left pes cavus conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The bilateral pes cavus condition was noted on limited duty forms, implicated in the NMA, and did not meet retention standards. 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 impairment from either foot would not have unacceptably interfered with military specialty performance, panel members agreed that each foot was reasonably justified as separately unfitting.

The panel directed attention to its rating recommendation based on the above evidence. As discussed above, the PEB adjudicated the bilateral foot condition as EPTS, SA, and rated 50%, coded 5278 with a 30% EPTS deduction. The PEB listed “soft tissue masses, bilateral feet” and “osseus equinus bilateral” as related Category II conditions contributing to the disability in this case. The panel concluded these diagnoses were not separate conditions which could be reasonably justified as unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The original VA Rating Decision rated the bilateral foot condition 30%, coded 5278, with deduction of a preservice percentage of 30% for a 0% rating, based on the May 2005 C&P examination. The 26 May 2006 VARD increased the rating of the bilateral pes cavus to 50%, with deduction of a preservice percentage of 10%, for a 40% rating based on the May 2006 C&P examination.

The PEB assigned the highest rating available under code 5278 for the bilateral pes cavus at separation. After having unbundled the bilateral pes cavus, the panel concluded there was no higher rating supported than that adjudicated by the PEB. The panel next considered an EPTS deduction, noting that the pre-enlistment sports medicine examination in October 2001 recorded bilateral pes cavus with ankle limitation, left hindfoot valgus, and occasional midfoot pain with prolonged walking. The panel agreed an EPTS deduction of 10%, but no higher, was appropriate for bilateral pes cavus based on the medical evidence just prior to service entry. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the bilateral pes cavus, coded 5278, with a 10% EPTS deduction for a permanent disability rating of 40%.

BOARD FINDINGS: In the matter of the bilateral foot condition, the panel recommends a disability rating of 50%, coded 5278 with an EPTS deduction of 10% for a permanent disability rating of 40% 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Symptomatic Pes Cavus, Bilateral	5278	40%	

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

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 30 Aug 19
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference {b)) to the Department of the Navy for appropriate action.

2.	On 5 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 20 to 40 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Office of the Deputy Commandant (Manpower and Reserve Affairs), for correction of your records as stated above.	You will be notified once those changes are complete.