RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05028
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “foot injuries, other” with a disability rating of 20%.  

CI CONTENTION:  His condition should have been rated 30% or higher for a 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 - 20090303	VARD - 20100622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries, Other	5284	20%	Posterior Tibial Tendonitis Right	5284-5024	0%	20100222	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Foot Injuries, Other.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s foot injuries began during his first tour of active duty.  Following reenlistment in 2005, his feet started hurting more with the increase in physical activity.  He was treated with duty limitations, orthotics (shoe inserts), medications, and physical therapy, but his symptoms persisted.  Bilateral weight bearing X-rays of the feet on 18 June 2008 showed mild bilateral pes planus (flat feet) and degenerative changes of the mid-foot.  An X-ray of the right foot on 11 August 2008 showed stable changes.  However, an MRI on 13 September 2008 showed inflammation of the posterior tibial tendon, but the plantar fascia was normal.  He was seen in orthopedics 10 days later and thought to have bilateral plantar fasciitis due to diffuse tenderness.  The gait was normal.  He was issued new orthotics and a night splint for each foot.  On follow-up in orthopedics on 2 October 2008, the gait remained normal and minimal tenderness was present.  However, the CI continued to have pain with prolonged standing or walking and was not able to return to full duty. 

The 24 December 2008 MEB NARSUM examination, 5 months prior to separation, noted ongoing bilateral foot pain despite treatment.  He had an administrative position and minimized the time on his feet which was beneficial.  On physical examination, the range of motion (ROM) and strength were normal.  He was tender over all aspects of the mid-foot.  His gait was abnormal due to pain. 

At the 19 February 2010 VA Compensation and Pension (C&P) evaluation, 9 months after separation, the CI reported ongoing bilateral foot pain, but had a normal gait and did not use an assistive device.  Three days later, he had a second C&P, for the feet, and reported that he had no limitations in work or the activities of daily living other than running or prolonged standing.  Tenderness to palpation was present on the physical examination.  The gait was normal and he could heel to toe walk.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right foot conditions 10% each with application of the bilateral factor, each coded 5284 (foot injuries, other), citing the condition as a moderate foot injury as he was able to ambulate, although with pain, and had preserved ankle and foot motion and strength.  The VA rated the foot condition 0%, coded 5284-5024 (foot injuries, other and tenosynovitis), based on the C&P examination, citing no evidence of painful or limited motion.  Tenderness was present, but most examinations showed a normal gait.  This supports an impairment no higher than moderate as adjudicated by the PEB.  The panel also considered rating under code 5310 (Group X muscles), but this provided no rating advantage to the CI.  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 foot condition.  

BOARD FINDINGS:  In the matter of the foot condition and IAW VASRD §4.71a, 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:

Exhibit A.  DD Form 294, dated 20170529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180007354 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