RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2018-00004 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051001

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

CI CONTENTION: Review requested of all unfitting conditions as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050715	VARD - 20060330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5003	20%	Right Foot Subtalar Joint Coalition	5283	10%	20050922	
			Left Foot Subtalar Joint DJD	5003-5284	10%	20050922	
Gastrointestinal Esophageal Stricture	Not Unfitting	Gastrointestinal Esophageal Stricture	7203-7346	10%	20050922	
Hyperlipidemia	Not Unfitting	Hyperlipidemia	7199-7114	NSC	20050922	
Dysthymic Disorder	Not Unfitting	No VA Examination	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Bilateral Foot Pain. The PEB combined the right and left foot conditions under a single disability rating, coded 5003 (arthritis, degenerative) and rated 20%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there

was no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if 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 right and left foot conditions is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral foot condition became symptomatic during a tactical road march in 2000, but with no specific injury noted. An orthopedic surgeon diagnosed tarsal coalition of the bilateral feet, requiring orthotics. A CT scan in December 2002 revealed degenerative changes of the subtalar joint space primarily on the right side with marginal spurring and what appeared to be a bony bridge on the medial aspect of the talocalcaneal joint posterior to the sustentacular tali on the right foot. Bilateral weight-bearing films in September 2004 revealed small bilateral calcaneal plantar spurs and a retrocalcaneal spur on the left foot. Os peroneum was noted bilaterally with mild to moderate talar beaking of the right foot.

During the 2 March 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported arthritis of both feet as was well as bunions. Physical examination revealed mild, bilateral hallux valgus and tenderness, but no edema. Full active range of motion (ROM) was recorded. The 20 April 2005 MEB NARSUM examination, 5 months before separation, noted CI complaints of bilateral foot pain that resulted in the inability to do any prolonged walking or standing. Physical examination showed bilateral tenderness inferior to the medial malleolus, bilaterally, minimal edema on the central forefoot (left greater than right), and paresthesia with dorsiflexion of the left ankle. Right subtalar joint ROM showed 5 degrees of eversion, 0 degrees of inversion and the left had 10 degrees of inversion and 5 degrees of eversion, with pain.  Pain was also recorded during dorsiflexion of both ankles.

At the 22 September 2005 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported degenerative arthritis and bunions. The examiner noted bilateral ankle tenderness both medially and laterally. There was no evidence of abnormal weight- bearing, edema, weakness or instability, and sensation was intact bilaterally. There was 10 degrees (normal 45) of plantar flexion bilaterally. At the 18 January 2006 C&P examination, 3 months after separation, the CI reported the inability to stand more than 30 minutes due to bilateral foot pain. The examiner recorded bilateral foot tenderness and found no limitations with standing or walking. Both ankles had dorsiflexion to 20 degrees and plantar flexion to 45 degrees, with joint function not additionally limited by pain, fatigue, weakness or lack of endurance.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral foot condition 20%, coded 5003 (degenerative arthritis), citing “rated as degenerative arthritis, two or more major joints with X-ray evidence and occasional exacerbations of incapacitating symptoms.” The VA rated each foot 10%, and coded the right foot condition 5283 (tarsal, or metatarsal bones, malunion of, or nonunion of) based on the STR, for moderate symptoms; and analogously coded the left foot condition 5003-5284 (foot injuries, other), based on the STR with objective findings of degenerative joint disease and moderate functional impairment.  Panel members first concluded that there was not a preponderance   of

evidence in the service records which overcame the presumption that the bilateral foot condition was reasonably considered separately unfitting.

The panel then considered its rating recommendation for each unfitting foot condition at the time of separation, and agreed there was evidence to support a 10% rating based on functional loss due to painful motion (§4.59). The NARSUM indicated mild edema, tenderness and paresthesia during dorsiflexion, and there was radiographic evidence of degenerative disease. Thus, the panel also considered whether code 5284 provided for a higher rating (§4.7). However, all panel members agreed that the impairment did not more nearly approximate “moderately severe” to support the next higher 20% rating under this code. There were no additional applicable codes that resulted in a higher rating. After due deliberation, considering all the evidence, the panel recommends a disability rating of 10% for the right foot condition and 10% for the left foot condition, coded 5003. As this results in no rating benefit to the CI, the panel recommends no change in the PEB adjudication for the bilateral foot condition.

Contended PEB Conditions: Gastrointestinal (GI) Esophageal Stricture, Hyperlipidemia and Dysthymic Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are 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 gastrointestinal esophageal stricture, hyperlipidemia and dysthymic disorder, the panel recommends no change from the PEB determinations as not unfitting. 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.

PD-2018-00004 

AR20190010879, 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.

PD-2018-00004