XXXXXXXXXX. 

Dear XXXXXXXXXX:

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX.	CASE:  PD-2017-05083
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Traffic Management Coordinator, medically separated for “pes planus” with a disability rating of 10%.

CI CONTENTION:  “My disabilities were more severe than what I was rated at.”  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 - 20070521	VARD - 20080325	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pes Planus 	5276	10%	Bilateral Pes Planus	5276	10%	20071120	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Foot Pes Planus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right tibia tendon repair in May 2003 for stage II tibial tendon dysfunction.  The CI improved postoperatively until December 2005 when the right ankle was inverted and the pes planus became fixed and progressed to stage III posterior tibial tendon dysfunction.  He underwent another tendon repair surgery in March 2006 with right gastrocnemius slide, triple arthrodesis and hardware removal.   He developed worsening right medial arch pain and nonunion at the talonavicular joint.  A partial revision of the talonavicular arthrodesis was done in October 2006 with a proximal bone graft.  The talonavicular joint and triple arthrodesis subsequently healed, but there was right navicular cuneiform degenerative joint disease.  Full weight bearing with rocker-bottom shoes was attained in March 2007.  The CI denied right ankle pain, but endorsed mid-foot pain at the navicular cuneiform joint.  He was unable to run due to right foot pain.  

The 27 March 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of right foot pain.  Physical examination of the right foot showed a well-aligned hind foot, although there was some residual flatness to his overall arch.  He dorsiflexed to past neutral at the tibiotalar joint with knee extended of flexed.  Plantar flexion was about 20 degrees (normal 45).  He had no subtalar or talonavicular joint motion, but did have some residual dorsiflexion and plantar flexion in his midfoot area with navicular cuneiform joint tenderness.  There was decreased sensation of the fourth and fifth toes, although swelling had abated in the foot.  The left foot was not examined.  Right foot X-rays showed a nice coalition of the talonavicular joint and an overall nice position of the triple arthrodesis.  The commander’s statement dated 6 April 2007 indicated the CI was still undergoing treatment and recovery from multiple right ankle injuries and surgeries, which would not allow him to return to regular duty.  An L3 profile was issued on 26 April 2007 for right foot pain with stage III flat foot (status post triple arthrodesis).  At a physical therapy range of motion (ROM) study on 1 May 2007, 2 months prior to separation, the right ankle measured 12 degrees of dorsiflexion (normal 20), 14 degrees of plantar flexion, 10 degrees of inversion and 6 degrees of eversion with loss of motion due to pain.  Contralateral left ankle dorsiflexion was 22 degrees, plantar flexion was 40 degrees, inversion was 40 degrees and eversion was 28 degrees.  During the 7 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported right foot numbness at the top of two toes and wore rocker bottom shoes.  Physical examination revealed decreased right foot ROM.  There was also moderate, symptomatic pes planus.  

At the 20 November 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported bilateral pes planus with constant pain.  Physical examination showed an abnormal gait due to right ankle loss of motion.  Bilateral foot examination revealed no painful motion, edema, disturbed circulation, weakness, atrophy of the musculature or tenderness.  There was a slight degree of valgus present, but no forefoot or mid-foot malalignment, deformity, medial tilting of the upper border of the talus, marked pronation, whole foot eversion or plantar surface tenderness.  The Achilles tendons revealed good alignment, but pes planus was present.  Right ankle dorsiflexion was 15 degrees and plantar flexion was 40 degrees with painful motion.  Left ankle ROM was normal.  At a VA clinic visit on 21 November 2007 the CI reported bilateral foot pain.  Physical examination revealed no edema, clubbing or cyanosis. 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5299-5276 (flatfoot, acquired), citing chronic foot pain with ROMs limited by pain.  The VA rated the bilateral foot condition 10%, coded 5276, based on the C&P examination, citing the weight bearing line over or medial to the great toe with inward bowing of the Achilles tendon and pain on manipulation and use of the feet.  

Panel members discussed whether the right foot condition warranted a higher rating.  A 20% rating for a unilateral severe disability requires “objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.”  The CI had no objective evidence of a marked foot deformity.  He did not have pain with manipulation, although there was painful ankle motion and mid-foot pain.  By the time of separation, there was no foot swelling or characteristic callosities noted.  Therefore, a higher rating for either bilateral or unilateral pes planus was not supported under code 5276.  The panel also considered a rating for limitation of ankle ROM under code 5271, but both the physical therapy and VA ROM examinations showed at best “moderate” ankle limitation of motion, which offers no rating advantage to the CI.  Panel members next considered a rating using code 5284 (foot injuries, other).  Although the CI experienced two right foot injuries and several operative procedures, the panel determine that the CI’s disability at the time of separation, consisting of right foot pain, moderate ankle limitation of motion and the ability to perform all activities of daily living, did not rise to the level of either a “moderately severe” or “severe” foot injury.  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 right foot condition.

BOARD FINDINGS:  In the matter of the right 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.