RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-05552
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Weather Forecast Journeyman, medically separated for “bilateral acquired flat feet” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20061018	VARD - 20070405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Acquired Flat Feet	5276	10%	Bilateral Pes Planus Deformity	5276	30%	20070224	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:  

Bilateral Acquired Flat Feet.  The PEB combined the left and right flat foot conditions as a single unfitting condition coded 5276 (flatfoot acquired) and rated 10%.  The approach by the PEB commonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of 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.  The evidence for the left and right flat foot conditions are presented together, with attendant recommendations regarding separate unfitness and rating if indicated.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI first noted significant foot pain after performing training drills in 2003, and then after running and walking long distances.  The initial diagnosis was complicated with symptoms similar to plantar fasciitis as well as shin splints.  At an orthopedic appointment on 29 March 2006, 8 months prior to separation, the CI endorsed bilateral foot pain aggravated by any weight bearing activity.  His diagnosis was documented as “acquired flexible flat feet.”  

The MEB NARSUM examination was undated, but most likely performed at the same time as the profile on 27 June 2006, 5 months prior to separation.  The CI continued to report bilateral foot pain, and the examiner noted tenderness and flexible pes planus of both feet.  The profile restricted running, jumping, rucksack carrying, and marching greater than one mile.  

At the 24 February 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI had pain along the bottom aspect of both feet.  Physical examination revealed bilateral pes planus and tenderness along the bottom the feet, but no gross deformities, swelling, loose motion, bony malunion/nonunion, or false joints.  The examiner noted painful ankle dorsiflexion and plantar flexion and callosities over the dorsal surfaces of the big toes.  There was no unusual shoe wear pattern and the CI did use corrective devices in his shoes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral flat feet 10%, coded 5276.  Utilizing the same VASRD code, the VA rated the bilateral pes planus 30%, based on the C&P examination, citing evidence of marked deformity, pain on manipulation and use, and characteristic callosities.  

Panel members first considered whether the bilateral foot condition was reasonably justified as separately unfitting, and agreed that the clinical pathology and examination findings clearly indicated that code 5276 was appropriate in this case.  This code allows for either a unilateral or bilateral rating of 10% for moderate symptoms with “pain on manipulation and use of the feet,” and 20% or 30% for severe symptoms with marked deformities, swelling on use and characteristic callosities.  Although there was evidence of callosities present on the dorsum of both great toes shortly after separation, the location was not typical and therefore not “characteristic” in the presence of a pes planus condition.  This clinical finding coupled with no evidence of unusual shoe pattern as well as the absence of marked deformities or local swelling led the panel to conclude that the CI’s symptomatology near the time of separation did not support the “severe” level of impairment for either 20% unilaterally or 30% bilaterally.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the bilateral rating of 10% was most appropriate and correlated well with the clinical evidence.  Therefore, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the flat feet condition.  

BOARD FINDINGS:  In the matter of the bilateral flat feet 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.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05552.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.