RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200918 SEPARATION DATE: 20030610 

BOARD DATE: 20130131 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (88M/Motor Transport Operator), medically 
separated for painful feet (metatarsalgia) condition. The CI did not respond adequately to 
conservative treatment and was unable to meet the physical requirements of her Military 
Occupational Specialty (MOS) or meet physical fitness standards. She was issued a permanent 
L3 profile and referred for a Medical Evaluation Board (MEB). Metatarsalgia was forwarded to 
the Physical Evaluation Board (PEB) IAW AR 40-501. Five other conditions, as identified in the 
rating chart below, were also forwarded on the MEB submission as meeting retention 
standards. The PEB adjudicated the painful feet condition as unfitting, rated 0%, with 
application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining 
conditions were determined to be not unfitting and therefore not ratable. The CI made no 
appeals, and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “As I get older my disabilities are worsening. It is difficult to walk long 
distances, every time I stand for periods longer than 15 minutes my feet swells up it is very 
difficult to find shoes that fit, I always have to buy a size bigger. I can’t climb steps, there are 
frequents chest pains, I get light headed or dizzy and my knees are always buckling, my hand 
and feet stays swollen and they hurt. When I walk I have to turn my foot in, in order to 
minimize the pain. What I can’t figure out is that they still haven’t told me what is wrong with 
me. I think that I was misdiagnose. I am not the same person.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 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 mild carpal tunnel and idiopathic 
edema conditions and the unfitting painful feet condition, to include the pes cavus, meet the 
criteria prescribed in DoDI 6040.44 for Board purview, and are accordingly addressed below. 
The other requested condition, bilateral knee 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: 

 

Service IPEB – Dated 20030219 

VA (4 Mos. Post-Separation) – All Effective Date 20030610 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Painful feet/metatarsalgia 

5099-5003 

0% 

B Metatarsalgia w/pes cavus 

5279-5278 

10% 

20031004 

Pes Cavus 

Not Unfitting 

Mild Carpal Tunnel 

Not Unfitting 

L Wrist, Carpal Tunnel 

8515 

10% 

20030930 

R Wrist, Carpal Tunnel 

8515 

10% 

20030930 

Mild L5 Nerve Root 
Paresthesias 

Not Unfitting 

L5 Nerve Paresthsias 

5299-5294 

NSC 

20030930 

Idiopathic Edema 

Not Unfitting 

Idiopathic Edema 

7199-7121 

NSC 

20030930 

Pregnancy 

Not Unfitting 

NO VA ENTRY 

 

.No Additional MEB/PEB Entries. 

R Knee Strain 

5099-5024 

10% 

20031004 

L Knee Strain 

5099-5024 

10% 

20031004 

0% X # / Not Service-Connected x 5 

20030930 

Combined: 0% 

Combined: 50% 



 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which her service-incurred condition continues to 
burden her. The Board wishes to clarify that it is subject to the same laws for service disability 
entitlements as those under which the Disability Evaluation System (DES) operates. The DES 
has neither the role nor the authority to compensate 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 Veterans 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. 

 

Painful Feet Condition. In May 2001, the CI developed gradual onset of bilateral foot pain 
without injury while at NTC training. She was maintained on temporary profiles and eventually 
referred to podiatry after X-rays and bone scans were negative. Podiatry diagnosed pes cavus, 
recommended custom orthotics and these did not give her significant relief. She was also 
evaluated by neurology that did not offer any further diagnoses. The permanent profile 
identified symptomatic pes cavus (very high arches) and documented the following limitations; 
all activities at own pace, distance and endurance, march up to 2 miles, lift up to 40 pounds, 
wear soft shoes with uniform, alternate Army Physical Fitness Testing as marked, pushups, sit-
ups and bicycle. The commander’s statement documented the CI was working her MOS as a 
Motor Transport Operator, but in a limited capacity as a clerk in the operation section to 
accommodate her limitations, specifically the need to sit to relieve the pain and swelling in her 
feet. 

 

At the MEB exam, the CI reported very mild chronic pain in both feet at rest with a pronounced 
worsening of the pain after 10 to 15 minutes of standing. She was able to walk up to two miles 
despite this pain. She used over-the-counter arch supports in some of her civilian shoes. The 
MEB physical exam noted mild symptomatic pes cavus with tenderness to pressure over the 
first metatarsal heads bilaterally. Neurologic findings were negative. The podiatry consultant 
documented normal palpable pulses and the feet were painful. Range-of-motion (ROM) was 
full and complete, but elicited a positive facies dolorosa, (grimace due to pain). X-rays of the 
right and left foot and ankle revealed no evidence of fracture, dislocation, arthritic or 
inflammatory changes. The bone scan was normal. The examiner diagnosed metatarsalgia, 
with moderate symptoms with prolonged walking and standing, preventing the wearing of 


military footwear. At the VA Compensation and Pension (C&P) exam after separation, the CI 
reported after driving for a long time, running or standing her feet and hands would swell 
cramp and become numb and painful. Her primary problems were with her feet. She denied 
ever having an electromyogram and nerve conduction testing. She reported she was given 
insoles but they were not helpful and that she had to wear shoes that were one size too large. 
The C&P exam additionally demonstrated hip flexion, extension at the leg, dorsiflexion of the 
foot, wiggling and curling of the toes, eversion of the foot, and extension of the toes were all 
normal and 5 of 5 motor strength. She was able to tandem walk and stand on heels or toes. 
She complained of pain with gripping movements and with walking but was not currently 
symptomatic. The bilateral lower leg, ankle and foot exams were without edema with normal 
ankle ROM and without Deluca observations. 

 

The Board directs attention to its rating recommendation based on the above evidence. This 
rating includes consideration of functional loss lAW VASRD §4.10 (Functional impairment), 
§4.40 (Functional loss), §4.45 (DeLuca), and §4.59 (Painful motion). The PEB and VA chose 
different coding options for the condition which had some implications on the rating for the 
Board to consider. The PEB’s DA Form 199 reflected application of the USAPDA pain policy for 
rating and its 0% determination was inconsistent with §4.71a standards. The VA assigned a 
rating of 10% coded analogous to 5279 (metatarsalgia) with 5278 (pes cavus) for bilateral foot 
pain which fits the clinical pathology and is consistent with §4.71a standards. The Board 
considered the 5278 code (pes cavus) and agreed the evidence does not support the higher 
rating under this criterion. There is no evidence of documentation of incapacitating episodes or 
peripheral nerve impairment which would provide for additional or higher rating. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable doubt), the Board recommends a disability rating of 10% for the painful feet 
condition. The action officer recommends analogous rating to 5278 with 5279, thus subsuming 
pes cavus and using 5279 as the primary code to capture the primary pain disability. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were mild carpal tunnel and idiopathic edema. The Board’s first charge with respect to these 
conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. The 
Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 
(Resolution of reasonable doubt) standard used for its rating recommendations, but remains 
adherent to the DoDI 6040.44 “fair and equitable” standard. The Board notes the CI had a 
negative evaluation for idiopathic hand and feet swelling by primary care and specialty care 
evaluations. Extensive evaluation of laboratory data was also noncontributory towards specific 
or further diagnoses. With regards to the mild carpal tunnel, the MEB exam did note a 
decreased sensation in both hands in the distribution of the median nerve with a positive 
Phalen’s sign on the left (specific test for median nerve pathology), however there is no 
evidence of functional impairment. Idiopathic hand and feet swelling were implicated in the 
commander’s statement; however, none of these conditions were profiled; and, none were 
judged to fail retention standards. All were reviewed and considered by the Board. There was 
no indication from the record that either of these conditions significantly interfered with 
satisfactory duty performance. After due deliberation in consideration of the preponderance of 
the evidence, the Board concluded that there was insufficient cause to recommend a change in 
the PEB fitness determination for any of the contended conditions and, therefore, no additional 
disability ratings can be recommended. 

 

 

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 painful feet condition was operant in this case 


and the condition was adjudicated independently of that policy by the Board. In the matter of 
the painful feet condition, the Board unanimously recommends a disability rating of 10%, coded 
5278-5279 IAW VASRD §4.71a. In the matter of the contended mild carpal tunnel and 
idiopathic edema conditions, the Board unanimously recommends no change from the PEB 
determinations as not unfitting. 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: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Painful feet/metatarsalgia 

5278-5279 

10% 

RATING 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120621, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxx, AR20130005077 (PD201200918) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)