RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04085
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cryptologic Linguist, medically separated for “acquired pes planus” with a disability rating of 10%.  

CI CONTENTION:  “VA currently rates the condition at 30% disabling.  Secondary conditions combine to equal 100% (permanent/total) disabled per VA.”   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 - 20060817	VARD - 20070307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Acquired Pes Planus	5276	10%	Bilateral Pes Planus, Plantar Fasciitis and Achilles Tendonitis	5276	10%	20061017	
Chronic Right Elbow Pain	Not Unfitting	Right Elbow Medial Epicondylitis with Ulnar Nerve	5206-5024	10%	20061017	
Raynaud Syndrome	Not Unfitting	Raynaud’s Phenomenon Bilateral Hands	7117	0%	20061017	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Acquired Pes Planus.  The PEB combined the right and left foot conditions under a single disability rating, coded 5276 (acquired flatfoot) 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’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 (STR) and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began in 2003 with increased running.  Medical history indicated high arches were noted during service entry and basic training, with progressive loss of the arches and symptoms more severe on the right.  Foot X-rays in 2004 were normal.  Increasing symptoms led to an eventual diagnosis of bilateral pes planus, but custom orthotics (shoe inserts), physical therapy, prolonged profile limitations, and lower leg casting did not relieve symptoms.  Foot X-rays in 2006 showed bilateral pes planus with normal ankle joints.  

During the 23 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported bilateral foot pain, fallen arches, and use of orthotics and non-narcotic medication for pain.  He also right foot sensation loss if he “walked or ran long distances sometimes.”  The examiner noted plantar tenderness greater on the right than left.  

At the 26 Apr 2006 the podiatry clinic MEB/PEB consult, 7 months before separation, the CI complained of 2 years of bilateral foot pain (right greater than left) with mild relief from inserts.  Physical examination showed 5/5 muscle strength in all four quadrants and in both feet without pain.  While he was non-weight bearing, he had high medial arches equal in size.  However, with weight bearing, both medial arches flattened, with reduced arch and pain greater on the right.  The heels were in a valgus formation while weight bearing, and corrected to varus with heel raising; weight bearing in functional foot orthoses showed inadequate correction and continued right heel valgus deformity.  The CI was able to do single heel raises, but was shaky and slow due to collapse of the foot.  Range of motion (ROM) was within normal limits in both feet, but with mild pain.  The 12 May 2006 MEB NARSUM examination, noted complaints of bilateral foot pain aggravated by activities, standing/walking for over 10 minutes, or carrying greater than 30 pounds.  The examiner cited the physical findings from the podiatry consult.  

At the 17 October 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported pain, weakness and fatigability in both feet including the arches, Achilles tendon area and ankles; orthotics helped reduce symptoms.  Physical examination showed a normal gait and bilateral tenderness of the plantar aspect and Achilles tendon (right greater than left).  There was a positive Helbing sign (abnormal Achilles tendon curving) bilaterally with Achilles malalignment, which was not corrected with manipulation.  There was no excessive callus formation or deformity noted on the plantar aspect of the feet and no abnormal shoe wear.  Foot X-rays were normal.  The examiner noted the reported chronic ankle pain was actually not of the ankle joint, but a component of the bilateral pes planus and Achilles tendonitis.  The diagnoses included bilateral pes planus, plantar fasciitis, and Achilles tendonitis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 10%, coded 5276 (acquired flat feet), citing moderate pain with weight bearing and motion of the feet with bilateral pes planus.  The VA also rated the bilateral foot condition 10%, coded 5276, based on the C&P examination, citing moderate symptoms of tenderness, inward bowing of the tendo-achillis, and pain on manipulation/use of the feet.  The 16 October 2008 VARD increased the pes planus rating to 30% effective 29 April 2008 (17 months remote from separation) based on May and July 2008 VA treatment notes and examination on 5 June 2008.  

In this case, bilateral foot pain or bilateral pes planus were profiled and considered to fail retention standards, and were implicated by the NARSUM and the commander’s statement.  The commander’s statement 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, panel members agreed that each foot was reasonably justified as separately unfitting.  

Under code 5276, criteria for a 10% (moderate) rating for bilateral or unilateral involvement includes: weight bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet.  The panel agreed that given the examination findings proximate to separation, neither foot more nearly approximated the next higher “severe” level (objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities).  The later increased VA rating was adjudged post-separation worsening.  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 bilateral pes planus. 

Contended PEB Conditions:  Chronic Right Elbow Pain and Raynaud Syndrome (Upper Extremities).  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The profile listed Raynaud Syndrome and comments included “may wear gloves,” and “no push-ups” with a U2 profile.  Per the NARSUM, the Raynaud’s had been profiled P2 since 2003 with a separate MEB returning the CI to duty.  The NARSUM examination noted right elbow tenderness with full active ROM and no instability.  Neither of the conditions were implicated in the commander’s statement nor failed retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral pes planus and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic right elbow pain and Raynaud Syndrome, the panel recommends no change from the PEB determinations as not unfitting.  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:

PD-2017-04085

AR20190011703, XXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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.

PD-2017-04085