RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20051216 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1101065 
BOARD DATE:  20120926 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty 1LT/O-2 (11A/Infantry Officer), medically separated 
for a chronic foot pain condition and a low back condition.  He did not respond adequately to 
conservative  treatment  for  either  condition  and  was  unable  to  fulfill  the  physical  demands 
within  his  Military  Occupational  Specialty  (MOS),  meet  worldwide  deployment  standards  or 
meet  physical  fitness  standards.    He  was  issued  a  permanent  L3  profile  and  referred  for  a 
Medical  Evaluation  Board  (MEB).    Chronic  bilateral  foot  pain  and  lower  back  pain  with 
compression  fracture  were  forwarded  to  the  Physical  Evaluation  Board  (PEB)  as  medically 
unacceptable IAW AR 40-501.  One other condition, as identified in the rating chart below, was 
forwarded  on  the  MEB  submission  as  a  medically  unacceptable  condition.    The  PEB  (PEB) 
adjudicated  chronic  foot  pain  secondary  to  hallux  valgus,  pes  planus  and  hammertoes  and 
chronic back pain secondary to a L2 compression fracture condition as unfitting, rated 10% and 
10%  respectively,  with  application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities 
(VASRD).    The  foot  condition  and  back  condition  were  determined  to  have  existed  prior  to 
service (EPTS), were permanently aggravated and no deduction was made.  The remaining MEB 
condition  was  determined  to  be  not  unfitting.    The  CI  made  no  appeals,  and  was  medically 
separated with a 20% disability rating.   
 
 
CI CONTENTION:  “Original board did not take into account the severity of my PTSD/depression 
or complications with feet or back.  I am currently rated 70% by the VA for PTSD/Depression. 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all cases.  The unfitting foot and low conditions meet the criteria prescribed in DoDI 6040.44 for 
Board purview, and are accordingly addressed below.  The PTSD/Depression condition is not 
within the Board’s purview.  Any conditions or contention not requested in this application, or 
otherwise outside the Board’s defined scope of review, remain eligible for future consideration 
by the Army Board for Correction of Military Records.   
 
 
RATING COMPARISON:   
 

VA (1 Mos. Post-Separation) – All Effective Date 20051217 

Service IPEB – Dated 20051108 
Condition 
Chronic Foot Pain 

Code 
5284 

Rating 
10% 

Chronic Back Pain 

5235 

10% 

Left Shoulder Trauma 
w/Superior Gleniod Labral 
Lesion 

Not Unfitting 

Condition 

Hammer Toes, Right Foot 
Hammer Toes, Left Foot 
Lumbar Disc Degeneration L1-L2  
with History of L2 Compression 
Fracture 
Left Shoulder  Strain w/Superior 
Glenoid Labral Lesion 

Code 
5282 
5282 

Rating 
10% 
10% 

Exam 

20050927 
20050927 

5235-5243 

0%* 

20050927 

5099-5024 

10% 

20050927 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Tinnitus 
Major Depression, Single 
Episode 

6260 
9434 

10% 
10%* 

20050927 
20050930 

0% X 1 / Not Service-Connected x 5 

Combined:  40%% 

 

*VARD 20100407 increased rating to 10% effective 20091222 (evidence reflects rating of 20%) 
**VARD 20100407 increased rating to 70% effective 20091222 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impairment  with  which  his  service-incurred  condition  continues  to 
burden  him.    The  Board  wishes  to  clarify  that  it  is  subject  to  the  same  laws  for  disability 
entitlements as those under which the Disability Evaluation System (DES) operates.  The DES 
has neither the role nor the authority to compensate service members for anticipated future 
severity or potential complications of conditions resulting in medical separation. That role and 
authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a 
different set of laws (Title 38, United States Code).  The Board evaluates DVA evidence proximal 
to  separation  in  arriving  at  its  recommendations,  but  its  authority  resides  in  evaluating  the 
fairness  of  DES  fitness  decisions  and  rating  determinations  for  disability  at  the  time  of 
separation.  The Board further acknowledges the CI’s contention for ratings for other conditions 
documented at the time of separation, and notes that its recommendations in that regard must 
comply with the same governance. 
 
Back Condition.  The CI sustained an injury during airborne operations in the summer of 2003, 
with  magnetic  resonance  imaging  (MRI)  findings  of  L-2  compression  fracture.    He  went  to 
ranger school, but was unable to complete due to back pain.  He was cleared to duty to deploy 
to Iraq for a year and while there sought treatment for worsening back pain due to the wearing 
of his combat gear which responded to nonsteroidal and muscle relaxant medications.  Upon 
his return he was seen by Chiropractic Care and Physical Therapy with some relief however, he 
continued to have problems with low back pain, exacerbated with heavy lifting, straining, and 
wearing load bearing equipment, Kevlar and other combat gear or ruck sack.  Lumbosacral X-
rays revealed no acute fracture or subluxation, but degenerative changes involving the inferior 
end-plate of  L-2.  Orthopedics documented there was no surgical indication for his back and 
recommended continued conservative treatment.  The profile limitations included unable to lift 
more than 40 lbs, no sit-ups, and an AFPT aerobic alternate event of either swimming or biking.  
The  commander’s  statement  additionally  documented  he  was  unable  to  road  march,  dig  a 
fighting  position,  and  perform  many  other  strenuous  infantry  tasks;  all  of  these  which  were 
critical  to  his  survival  in  combat.    There  were  two  goniometric  range-of-motion  (ROM) 
evaluations  in  evidence,  with  documentation  of  additional  ratable  criteria,  which  the  Board 
weighed in arriving at its rating recommendation; as summarized in the chart below.   
 
 

MEB ~7 Mo. Pre-Sep 

VA C&P ~3 Mo. Pre-Sep 

Thoracolumbar ROM 
Flexion (90⁰ Normal) 

Ext (0-30) 

R Lat Flex (0-30) 
L Lat Flex 0-30) 
R Rotation (0-30) 
L Rotation (0-30) 
Combined (240⁰) 

Comment 

§4.71a Rating 

90⁰ 
30⁰ 
25⁰ 
25⁰ 
>30⁰ 
>30⁰ 
230⁰ 

motion 
10%* 

+ Tenderness; painful 

90⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
240⁰ 

+ Tenderness 

0% 

 

*Conceding painful motion §4.59 

   2                                                           PD1101065 
 

The  MEB  physical  exam  documented  tenderness  to  palpation  of  the  lumbosacral  spine 
musculature,  normal  heel,  toe  and  tight  rope  walk,  normal  squat,  normal  neuromuscular 
findings and negative Waddell signs.  The medical examiner diagnosed back pain that continued 
to require restriction of activity and limitation of function and opined a pain scale severity of 
slight  and  constant.    At  the  VA  Compensation  and  Pension  (C&P)  exam,  the  CI  reported 
constant pain, 4 to 6 of 10 in intensity, increased with activity, relieved with rest and he could 
function without medication.  He reported his back pain did not cause incapacitations or any 
time  lost  from  work.    The  C&P  exam  documented  normal  gait,  no  noted  muscle  spasm, 
tenderness, and negative straight leg raise (SLR) bilaterally.  
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board  directs  attention  to  its  rating  recommendations  based  on  the  above  evidence  which 
includes consideration of functional loss lAW VASRD §4.10, §4.40, §4.45 and §4.59.  The Board 
notes that both the MEB and VA exams were complete, well documented, and compliant with 
VASRD §4.46 (accurate measurement) and similar in terms of ratable data and therefore the 
Board  assigns  both  exams  equal  probative  value.    The  PEB  and  VA  chose  different  coding 
options for the condition, but this did not bear on rating and both were IAW §4.71a—Schedule 
of ratings–musculoskeletal system under the general rating formula for diseases and injuries of 
the spine.  The PEB rated 10% coded 5235 (Vertebral fracture or dislocation) based on painful 
motion which is consistent with a rating IAW §4.59.  The VA rated 0% based on normal ROMs 
and  no  evidence  of  pain  on  motion.    The  Board  considered  VASRD  §4.7  (higher  of  two 
evaluations) during its deliberation which directs the evaluator to assign the higher of two valid 
ratings if the disability picture more nearly approximates the criteria.  The Board agreed the 
functional impairment of the CI’s back condition due to pain more nearly approximates the 10% 
criteria.  The Board considered the VA analogous code to 5243 (Intervertebral disc syndrome) 
which allows for consideration of incapacitating episodes however agreed the evidence lacked 
either physical or radiographic signs of this condition or evidence of incapacitation episodes.  
There  is  no  evidence  of  ratable  peripheral  nerve  impairment  in  this  case.    After  due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication for the back condition.   
 
Chronic Foot Pain Condition.  The CI first noted some symptoms with his feet with numbness 
and tingling in basic training in 2002 but these symptoms resolved until his return from Iraq in 
March 2004.  After an increased in his running mileage, the CI noted pain across his toes, with 
progression  of  pain  to  bottom  of  the  foot,  into  the  heels  and  ankles.    He  was  treated  with 
inserts nonsteroidal medications and limited profiles.  Podiatry evaluated him in January 2005 
with X-rays and an exam.  The examiner noted hammertoes and bunions, along with plantar 
fasciitis and recommended surgery.  After surgical counseling the CI opted for an MEB.  The 
profile  and  commander’s  statement  corroborated  his  bilateral  foot  pain  condition  with 
limitations preventing running, jumping, climbing, standing for long periods, or impact activities 
on the feet.  The MEB physical exam demonstrated abnormal anatomy with bilateral bunions 
(Hallux  valgus),  pes  planus  (flat  feet)  and  hammertoes  diffusely  of  toes  2-5,  pain  elicited  by 
motion of the feet with first toe joint ROM, no swelling or erythema, and minimal tenderness to 
palpation of the feet.  X-rays revealed left foot mild hallux valgus and right foot normal study.  
The medical examiner diagnosed chronic pain and dysfunction of feet and opined a pain scale 
severity of slight and constant.  At the C&P exam prior to separation, the CI reported a similar 
history, diagnoses and additionally noted he had not had any time lost from work.  The exam 
bilaterally  demonstrated;  no  tenderness,  weakness,  edema,  atrophy  or  disturbed  circulation. 
Pes planus was not present.  He had hammer toes of the right and left foot, including toes 2, 3, 
4, 5.  He did not have any limitation with standing or walking.  He required arch supports.  The 
symptoms and pain were relieved by the previously noted corrective shoe wear.  X-rays of the 
right  and  left  foot  (non  weight  bearing)  revealed  hammertoes,  2,3,4,5  digits.    The  examiner 
diagnosed hammertoes and did not have findings of bunions or plantar fasciitis. 

   3                                                           PD1101065 
 

 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB did not specifically adjudicate the bilateral foot condition as it was presented in the MEB 
and evidenced before the PEB but rather adjudicated chronic foot pain with a unilateral VASRD 
code.  The Board agreed there was no specific evidence to elucidate if this was an erroneous 
error  on  behalf  of  the  PEB  or  if  the  PEB  did  consider  the  foot  condition  as  bilateral.    All 
members agreed that the bilateral foot condition, as an isolated right and left foot condition, 
would  have  rendered  the  CI  incapable  of  continued  service  within  his  MOS,  and  accordingly 
merits  a  bilateral  foot  VASRD  code  or  separate  service  rating  for  each  foot  with  a  unilateral 
code  with  consideration  of  VASRD  §4.7  (higher  of  two  evaluations).    The  PEB  and  VA  chose 
different  coding  options  for  the  condition  and  both  were  IAW  §4.71a—Schedule  of  ratings–
musculoskeletal  system.    The  PEB  chose  code  5284  (foot  injuries,  other),  a  VASRD  unilateral 
code,  and  rated  10%  for  moderate.    The  VA  chose  to  rate  each  foot  10%  with  code  5282 
(hammertoes)  for  the  symptomatic  hammertoes  and  further  noted  there  was  no  current 
pathology consistent with hallux valgus, pes planus or plantar fasciitis.  The Board considered 
the 5310 plantar muscle code which is commonly used for plantar fasciitis but agreed this is not 
the predominant disabling diagnosis at the time of separation.  The Board agreed while there 
were multiple foot conditions contributing to the CI’s bilateral foot pain, IAW §4.14, avoidance 
of  pyramiding,  the  Board  agreed  the  hammertoes  and  hallux  valgus  were  the  dominant 
disabling conditions and the evidence most closely approximated moderate pain impairment of 
the  left  and  right  foot.    The  Board  considered  the  5181  code  (hallux  valgus)  however  the 
evidence  reflects  mild  hallux  valgus  on  the  MEB  which  would  rate  at  0%  and  further  no 
evidence of this condition on the VA exam.  Finally, IAW §4.7, all Board members agreed both 
exams  reflect  bilateral  hammertoes  and  the  CI  is  functionally  impaired  due  to  painful  feet.  
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 each foot condition.   
 
 
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  low back  condition  and  IAW  VASRD  §4.71a,  the  Board 
unanimously recommends no change in the PEB adjudication.  In the matter of the right and 
left foot condition, the Board unanimously recommends a disability rating of 10% each, coded 
5282 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; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 

VASRD CODE 

RATING 

5235 
5282 
5282 

COMBINE (w/ BLF) 

10% 
10% 
10% 
30% 

Chronic Back Pain 
Chronic Left Foot Pain 
Chronic Right Foot Pain 

 
 
 
 
 

   4                                                           PD1101065 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111104, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   5                                                           PD1101065 
 

 
 

 
 

 
 
 

a.  Providing a correction to the individual’s separation document showing that the 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXX, AR20120018958 (PD201101065) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 30% 
effective the date of the individual’s original medical separation for disability with severance 
pay.   
 
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: 
 
 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with severance pay. 
 
 
effective the date of the original medical separation for disability with severance pay. 
 
 
c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 30% 
effective the date of the original medical separation for disability with severance pay. 
 
 
medical TRICARE retiree options. 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 

b.  Providing orders showing that the individual was retired with permanent disability 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

     XXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   6                                                           PD1101065