RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

 

           SEPARATION DATE:  20040519 

 
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX                                         BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1101079 
BOARD DATE:  20120921 
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (31B, Military Police) medically separated for 
a  bilateral  foot  condition.    She  experienced  an  onset  of  bilateral  foot  pain  in  2001,  which 
persisted and worsened throughout her remaining years of service.  She underwent extensive 
ancillary and specialty evaluations without a definitive diagnosis.  The condition could not be 
adequately  rehabilitated  to  meet  the  physical  requirements  of  her  Military  Occupational 
Specialty (MOS) or satisfy physical fitness standards.  She was consequently issued a permanent 
L3  profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  bilateral  foot  condition, 
characterized as “bilateral foot pain and hyperesthesia – unknown etiology,” was forwarded to 
the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.    No  other 
conditions  were  submitted  by  the  MEB.    The  PEB  adjudicated  the  bilateral  foot  condition  as 
unfitting, rated 10% analogously to code 5003 (degenerative arthritis), citing criteria of the US 
Army  Physical  Disability  Agency  (USAPDA)  pain  policy.    The  CI  made  no  appeals,  and  was 
medically separated with that disability rating. 
 
 
CI CONTENTION:  The application states “I was medically discharged and denied an opportunity 
to reclassify.  My Tarsal Tunnel Syndrome was also denied a disability rating and that was why I 
was discharged.”  She does not elaborate further or specify a request for Board consideration of 
any additional conditions.  
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
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 rating for the unfitting foot condition is addressed 
below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  
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 (ABCMR). 
 
 
RATING COMPARISON:  
 

Service PEB – Dated 20040115  

Condition 

Code 

Rating 

Bilateral Foot Pain and 
Hyperesthesia 

5099-5003 

0% 

No Additional MEB/PEB Entries. 

VA (2 Mo. Pre-Separation) –Effective 20040520 
Condition 
Rating 

Code 

Tarsal Tunnel Syndrome, L  Foot 
Tarsal Tunnel Syndrome, R Foot 
Gastroesophageal Reflux Disease 
Impingement Syndrome, R Shoulder 

8599-8525 
8599-8525 
7399-7346 
5299-5203 

0% 
0% 
10% 
0% 

Exam 

20040305 
20040305 
20040305 
20040305 

Not Service Connected x 3 

20040305 

Combined:  10% 

Combined:  0% 

 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s grievance that she was not given the 
opportunity to reclassify into an alternate MOS and continue her service.  It is noted for the 
record that the Board has neither the jurisdiction nor authority to scrutinize, render opinions, 
or offer remedy in reference to Service decisions of this nature.  That jurisdiction and authority 
resides  with  the  ABCMR.    IAW  DoDI  6040.44,  the  Board’s  authority  is  limited  to  making 
recommendations on correcting disability determinations.  The Board’s role is thus confined to 
the  review  of  medical  records  and  all  evidence  at  hand  to  assess  the  fairness  of  PEB  rating 
determinations, compared to VASRD standards, based on severity at the time of separation. 
 
Bilateral Foot Condition.  There was no antecedent injury for the CI’s November 2001 onset of 
bilateral foot pain, and she first sought medical care for worsening symptoms in February 2002.  
She  was  managed  conservatively  with  temporary  profiles  until  a  May  2002  deployment  to 
Afghanistan.    Her  symptoms  worsened  with  the  rigors  of  the  deployment,  and  she  required 
medical evacuation after 3 months.  Upon redeployment she underwent extensive evaluation; 
which included consults with neurology, podiatry, and physical/occupational medicine.  Those 
evaluations  document  a  symptom  complex  of  bilateral  stocking  pattern  pain  with  exquisite 
sensitivity  to  touch  and  pressure,  and  an  inability  to  tolerate  regulation  footwear  or  engage 
prolonged walking or standing.  The work-up included negative imaging and numerous nerve 
studies  which  failed  to  demonstrate  definitive  peripheral  nerve  impairment;  although,  a  late 
MEB study (November 2003) did show “EDX [electrodiagnostic] evidence of a right sided lateral 
plantar  neuropathy.”    It  was  felt,  however,  that  this  finding  did  not  fully  account  for  the 
bilateral stocking pattern of pain.  Relevant to her contention, the CI was referred to a MOS 
Medical Review Board (MMRB) which recommended an MEB rather than reclassification.  The 
narrative  summary  (NARSUM)  noted  constant  bilateral  foot  pain  rated  5/10,  “worsening  to 
10/10 with any weightbearing and wearing any type of footwear.”  The physical examination 
noted  diffuse  bilateral  tenderness  “from  the  calcaneus  [heel]  distally  to  the  toes,  worsening 
distally.  Sensation was intact and painful.  Bilateral dorsiflexion and plantarflexion strength was 
5/5.    She  did  have  pain  to  contact  for  resisted  movement  of  strength  testing.”    The  VA 
Compensation  and  Pension  (C&P)  evaluation  (2  months  prior  to  separation)  noted  “pain, 
swelling  and  fatigue”  at  rest,  with  the  addition  of  “weakness”  to  those  symptoms  “while 
standing  or  walking.”    The  VA  examiner  noted  that  the  CI  had  been  desk  bound  due  to  her 
condition, but had lost no time from work.  The VA physical examination was cursory, noting 
bilateral tenderness without further elaboration (absence of pes planus was confirmed).  Gait 
was normal, as were bilateral ankle range-of-motion (ROM) measurements. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board first considered if a combined bilateral rating, as per the PEB approach, was appropriate 
and  the  most  favorable  rating  IAW  VASRD  §4.7  (higher  of  two  evaluations).    Bilateral  rating 
analogous to 5003 also poses conflict with the VASRD, since there were no confirmatory X-ray 
findings nor is arthritis an accurate clinical descriptor for the pathology in evidence.  None of 
the bilateral foot rating options IAW VASRD §4.71a (pes planus, claw foot, metatarsalgia) are 
clinically applicable; with the possible exception of an analogous rating under 5277 (weak foot) 
yielding a bilateral rating of 10%).  In consideration of separate ratings in lieu of PEB combined 
ratings, the Board must also consider separate fitness assessments which justify each disability 
rating.    It  is  clear,  however,  that  the  symptoms  and  limitations  described  above  would  have 
rendered  the  CI  unable  to  meet  the  demands  of  her  MOS  even  if  confined  to  a  single  foot.  
Members concurred therefore that each foot should be conceded as separately unfitting; and, 

that coding and rating features were logically identical.  The Board next considered the proper 
coding  for  separate  rating.    With  the  absence of  any  compensable  ROM  limitations  or  other 
orthopedic joint abnormality, there are no good analogous coding fits under §4.71a.  The Board 
notes,  however,  that  the  disability  in  this  case  is  a  good  analogous  fit  with  peripheral  nerve 
coding in alignment with the VA approach.  Although in agreement with the MEB conclusion 
that no rigid clinical diagnosis of peripheral neuropathy (specifically tarsal tunnel syndrome) can 
be based on the ancillary findings, the action officer opines that the manifest symptoms are 
fairly  akin to  complex  regional pain  syndrome which  is  unequivocally  rated  as  a neuropathy.  
The  nerve  code  8525  (posterior  tibial)  which  the  VA  applied  in  conjunction  with  the  VA 
examiner’s working diagnosis of tarsal tunnel syndrome is the anatomically applicable code in 
this  case  for  analogous  rating  as  a  neuropathy,  although  8725  (posterior  tibial  neuralgia)  is 
more  clinically  concordant.    IAW  VASRD  §4.124  neuralgia  may  be  rated  no  higher  than 
‘moderate’ nerve impairment; which for 8625 is 10% (10% is also the rating for ‘mild’ under 
8625).  Members considered application of 8625 (posterior tibial neuritis); which, IAW §4.123, 
may  be  rated  as  high  as  ‘severe’  nerve  impairment  (yielding  a  20%  rating  under  8625);  but, 
§4.123  defines  neuritis  as  “characterized  by  loss  of  reflexes,  muscle  atrophy,  sensory 
disturbances,  and  constant  pain,  at  times  excruciating.”    Although  constant  and  occasionally 
excruciating  pain  was  evidenced,  there  were  no  motor,  sensory,  or  reflex  abnormalities.  
Although the VA rater concluded that the severity in this case did not meet the compensable 
‘mild’ threshold of 8525; all members agreed that at least ‘mild’, if not ‘moderate’, was a fair 
characterization  of  the  disability  in  evidence.    After  due  deliberation,  considering  all  of  the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends separate right 
and left disability ratings of 10% each for the bilateral 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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating the foot condition was operant in this case and it 
was adjudicated independently of that policy by the Board.  In the matter of the bilateral foot 
condition, the Board unanimously recommends that each foot be rated as separately unfitting 
at  10%,  coded  8799-8725,  IAW  VASRD  §4.124a.    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 her prior medical separation: 
 

 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111110, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans’ Affairs Treatment Record. 

 

UNFITTING CONDITION 

Chronic Pain and Neuralgia, Left Foot 
Chronic Pain and Neuralgia, Right Foot 

VASRD CODE  RATING 
8799-8725 
8799-8725 
COMBINED (w/ BLF) 

10% 
10% 
20% 

 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA 22202 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXXXXX, AR20120017711 (PD201101079) 
 
 
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 20% 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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)