RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04821
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Infantryman, medically separated for “bilateral foot pain” with a disability rating of 0%. 

CI CONTENTION:  “PTSD was new and just considered 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 – 20050719 	VARD – 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5276	0%	Bilateral Pes Planus	5276	10%	20060215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began in November 2004, 1 month into basic training, after running.  On examination, he was noted to have bilateral pes planus and ankle pain with tenderness of the left distal fibula.  X-rays of the left foot and left ankle were normal.  

The 17 May MEB podiatry consult, 3 months prior to separation, noted complaints of sharp and aching pain to both heels and medial arches.  The pain increased with weight bearing activities and wear of military footgear.  The CI denied trauma to his feet and was not interested in surgery.  Physical examination revealed no edema, but there was tenderness of the plantar medial heel as well as the plantar medial longitudinal arch bilaterally.  There was hypermobility of the first ray bilaterally and the heel was in a valgus position on weight bearing.  There was excessive pronation on gait analysis.  X-rays of both feet revealed a decreased medial longitudinal arch.  The diagnosis was pes planus, symptomatic, with excessive pronation on weight bearing, which prevented the wear of military footwear.  

During the 6 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the physical examination showed pes planus with tenderness in the arches with no swelling or redness.  The 5 July 2005 MEB NARSUM examination, 1 month prior to separation, noted decreased complaints of pain because the CI was not active and had not done any physical training in the prior 2 months.  The examiner noted the CI’s MEPS physical in 2003 was unremarkable (normal arches of the feet were noted).  Physical examination showed moderate bilateral pes planus with tenderness to palpation in the arches.  There was no redness or swelling and the neurovascular examination was normal.  

At the 15 February 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported increased foot pain with activity.  Physical examination showed a normal posture and gait.  The feet showed no signs of abnormal weight-bearing.  There were no signs of painful motion, edema, disturbed circulation, weakness, atrophy or tenderness in the feet or toes.  There was pes planus in both feet with no valgus or forefoot malalignment.  There were no findings of inward rotation, medial tilting, marked pronation, forefoot dorsiflexion, plantar tenderness or Achilles malalignment.  There was no pes cavus, hammertoes or Morton’s metatarsalgia.  Hallux valgus was present in both first metatarsophalangeal joints, moderate on the right and slight on the left.  There was no hallux rigidus and no obvious limitation of function for standing or walking.  No obvious corrective shoe wear was being used.  X-rays of each foot revealed moderate bilateral pes planovalgus with weight-bearing.  There was no hallux valgus or varus deformity or bunion and no tarsal coalition or features of a heel spur.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral foot condition 0%, coded 5276 (flatfoot, acquired), citing mild disability.  The VA rated the bilateral foot condition 10%, coded 5276, based on the C&P examination, citing symptomatic bilateral pes planus.    

Panel members noted code 5276 for mild symptoms is not broken down into bilateral or unilateral.  Therefore, the panel majority determined that each foot warranted a separate rating of 0% for each foot.  However, a rating of 0% for each foot offers no benefit to the CI.  Furthermore, members noted that the CI’s bilateral pes planus condition was reported to be moderate on examination and by X-rays with weight bearing, but symptoms improved in the absence of physical training.  A 10% rating requires “moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo Achilles, pain on manipulation and use of the feet, bilateral or unilateral.”  Clinical findings did not support the required findings.  However, the minority voter felt the bilateral condition more closely approximated a 10% rating.  The panel majority agreed that a 10% rating was not warranted nor would use of any other foot code provide a higher rating than the 0% adjudicated by the PEB.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral foot condition.  

BOARD FINDINGS: In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10% but elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170504, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180006730, XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure