RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04431
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “chronic bilateral foot pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “The military failed to [consider] the secondary effects from the bilateral feet issues which DoD granted at 20%.  The military also failed to [consider] the fact that [the CI] was being treated for anxiety and depression.”  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 - 20090508	VARD - 20100112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5299-5284	20%	Plantar Fasciitis, Left Foot	5299-5284	20%	20091105	
			Plantar Fasciitis, Right Foot	5299-5284	20%	20091105	
Adjustment Disorder 	Not Compensable	Adjustment Disorder 	9440	30%	20091120	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began gradually in January 2008.  She was treated with custom orthotics, steroid injections and activity limiting profiles.  Initially she had very good pain relief and then began complaining of left foot pain again after a physical fitness test in July 2008.  In October 2008, she was treated with oral steroids for 15 days and then other anti-inflammatory medications which again gave initial relief but pain returned in December 2008.  Her podiatrist did not recommend surgery.  

At the 18 February 2009 MEB podiatry addendum, 5 months prior to separation, the CI reported left worse than right foot pain and a pulling sensation in both feet.  She described pain along the bottom of both feet as stepping on a knife.  On physical examination, there was pain with dorsiflexion and plantar flexion of both ankles.  Both feet were noted to be hypermobile in the first ray and the bottoms of the feet were found to be turned inward, left more than right.  The gait and stance were normal.  

The 1 April 2009 MEB NARSUM examination, 3 months prior to separation, noted left worse than right bilateral foot pain.  She was unable to perform a physical fitness test, move with a fighting load, run, jump, march, lift more than 20 pounds or stand for more than 20 minutes.  Physical examination showed tenderness of the plantar surface of the feet bilaterally.  With weight bearing, the left navicular bone protruded to be almost as prominent as the medial malleolus; however, the right showed only mild prominence.  Gait was wide-based and short-stepped with mild waddling.  She used no adaptive devices other than orthotic inserts.  

At the 5 November 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported foot pain, medial ankle pain and heel pain going up the back of the calves, which prevented her from walking more than a few yards or standing longer than 15 or 30 minutes.  Sometimes her feet were so sensitive that it hurt to put on shoes.  She stated she was using custom orthotics and used a cane one or two times per month when the pain was unbearable.  Physical examination demonstrated an antalgic gait and tenderness at the insertion of the plantar fascia and along the arch bilaterally.  There was pain on manipulation of the left foot but not the right.  There was no atrophy of foot muscles on either side.  Both ankles were stable and demonstrated full range of motion without pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each foot 10%, coded 5299-5284 (analogous to foot injuries, other), citing “moderate” disability.  The VA rated each foot 20%, also coded 5299-5284, based on the C&P examination, citing moderately severe symptoms.  The panel agreed that the left and right foot conditions were no more than moderate under code 5284. Although the examination findings were best characterized by Group X muscle injuries (5310), which includes the plantar aponeurosis (plantar fascia), or Group XI muscle injuries (5311), which includes the tibialis posterior, and were most consistent with moderate disability bilaterally for a 10% rating for each foot, this did not constitute a rating advantage to the CI over code 5284.  There was no evidence of claw foot (5278), hammer toe (5282) or severe hallux valgus (5280) in either foot to justify a rating under the respective codes.  There were no fractures with nonunion (5283) in either foot to justify a rating using that code.  There was no evidence of metatarsalgia to substantiate a 10% rating using code 5279.  There was no evidence of acquired flat foot (5276) to substantiate a rating using that code.    After due deliberation, considering all of 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 foot condition.  

Contended PEB Condition:  Adjustment Disorder.  The panel notes the adjustment disorder is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder, the panel agrees it cannot recommend it for additional disability rating.  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:

AR20190007290, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.