RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01579
BRANCH OF SERVICE:  Army	BOARD DATE:  20150325
Separation Date:  20031109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Trainee) medically separated for a right foot condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right foot condition, characterized as “right foot acquired flat foot secondary to previous Lisfanc joint sprain with delayed diagnosis,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right foot acquired flat foot following Lisfranc joint sprain” as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My broken right foot at the arch caused by a sudden impact permanently disfigured my right foot exasperated by doctor’s failure to realize foot broken until my arrival at Fort Sam (SATX) for AIT.  Now my foot is causing a permanent progressive degenerative lower back condition.  A cause of much pain.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20031007	VA - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Acquired Flat Foot following Lisfranc Joint Sprain	5276	0%	Pes Planovalgus of the Right Foot with Calcaneal Heel Spur…	5299-5276	20%	20040127	
Other x0	Other x3	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20040614 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Right Foot Acquired Flat Foot following Lisfranc Joint Sprain Condition.  The CI developed right foot pain after stumbling on an obstacle course in November 2002.  His foot was plantar flexed and he jammed the tip of his toes when it was caught between logs.  The medical provider noted swelling and pain with bruising on the bottom and side the right foot as well.  He was diagnosed with a foot sprain and advised that time would heal the pain.  The physical therapist (PT) noted right foot chronic pain and that the foot appeared to have lost the longitudinal arch.  The PT referred the CI to orthopedics.  Bone scans demonstrated stress-related change in the metatarsophalangeal (MP) joints of the right foot, bilateral shin splints and stress changes in the right calcaneus.  Magnetic resonance imaging showed mild tenosynovitis.  The Orthopedist noted right foot pain and pes planus with a right Lisfranc sprain.  The examiner ordered a molded soft arch support for the shoe and he discussed possible surgical options.  The MEB narrative summary exam a month prior to separation documented that the CI had only mild pain when he did not run.  There were physical exam findings of a moderately decreased arch and an acquired flat foot on the right without discrete tenderness to palpation, swelling or edema.  There was no evidence of any fracture or stress changes.  The VA Compensation and Pension exam approximately 2 months after separation documented that at rest, the CI had right foot pain, stiffness and swelling.  He also had functional impairments of an inability to run, jump or perform weight bearing activities.  There were physical exam findings of moderate pes planus and forefoot/mid-foot mal-alignment, and moderate tenderness to palpation of the sole of his right foot.  A right foot X-ray showed a severe pes planovagal deformity, a small posterior heel spur and minimal degenerative arthritic change in the first MP joint.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the right foot acquired flat foot following Lisfranc joint sprain as 5276 (acquired flatfoot) and rated at 0% citing “mild.”  The VA coded the pes planovalgus of the right foot with calcaneal heel spur and plantar fasciitis condition as 5299 analogous to 5276 and rated at 20%.  The Board reviewed the “severe” (20%) rating criteria as granted by the VA and agreed that the evidence does not support that marked deformity, swelling on use, and characteristic callosities were present at the time of separation.  The Board deliberated if the CI’s right foot condition was closer to the 10% or 0% disability level under analogous coding of 5276.  Given the CI’s persistent tenderness and failure of custom ache supports to relieve his symptoms, the Board adjudged that the CI’s right foot condition exceeded “mild” and more closely reflected the “moderate,” 10%, disability rating.  The Board also considered application of VASRD code 5284 (other foot injuries) but adjudged that the CI’s level of disability did not meet the subjective “moderately severe” level as required for the 20% rating level.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right foot acquired flat foot following Lisfranc joint sprain condition coded 5299-5276.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right foot acquired flat foot following Lisfranc joint sprain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Foot Acquired Flat Foot following Lisfranc Joint Sprain	5299-5276	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150011086 (PD201301579)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA