RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX CASE: PD1201845 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130411 

SEPARATION DATE: 20030315 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SFC/E-7 (02SP5/Special Bandsman) medically 
separated for bilateral foot pain. He experienced an onset of foot problems in 1997; was seen 
extensively by podiatric providers; underwent an array of treatments as well as four surgeries 
between 2000 and 2001. The foot pain could not be adequately rehabilitated to meet the 
physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board 
(MEB). The bilateral foot condition, characterized as “neuralgia,” was forwarded to the Physical 
Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The 
PEB adjudicated “bilateral foot pain” as unfitting, rated 0%, citing criteria of the US Army 
Physical Disability Agency (USAPDA) pain policy. The CI appealed to the Formal PEB (FPEB), 
which affirmed the PEB findings; and, was thus medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “Upon discharge, I met with a new surgeon for evaluation. The nerve bundles 
in both L & R Tarsal Tunnel were 90% dead. He performed a micro-scopic level tarsal tunnel 
release which provided better relief-but I will never, ever be 100% back to normal use. I have 
continued to experience continued lower back problems, which was not a part of the original 
board, but I have asked VA to re-open that claim. Recent MRI reveals that I have arthritis @ L4-
5 & a herniated disc-which may be service connected. I have medical record of a back injury 
Oct, 1999. Also, due to the nature of my former job (ceremonial unit-Fife & Drum Corps) – 
Many members of the unit end up with back and feet issues because of the nature of mission.” 

 

 

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 those conditions identified but not determined to be unfitting by 
the PEB when specifically requested by the CI. The rating for the unfitting bilateral foot 
condition is addressed below; the requested back condition was not identified by the PEB, and 
thus is not within the DoDI 6040.44 defined purview of the Board. This and any other 
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 Board for Correction of 
Military Records. 

 

 


RATING COMPARISON: 

 

Service FPEB – Dated 20021214 

VA - (10 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Foot Pain 

5099-5003 

0% 

Status Post Left Tarsal Tunnel and 
Plantar Fascia Release with Neuralgia 

8721-5283 

10% 

20030328 

Status Post Right Tarsal Tunnel and 
Plantar Fascia Release with Neuralgia 
(also claimed as Bilateral Ankles, 
Achilles Tendonitis, Hammertoes and 
Foot Fracture) 

8721-5283 

10% 

20030328 

No Additional MEB/PEB Entries 

Other x 7 

20030328 

Combined: 0% 

Combined: 20% 



Derived from VA Rating Decision (VARD) dated 20040127 (most proximate to date of separation [DOS]). 

 

 

ANALYSIS SUMMARY: The PEB combined the bilateral foot pain conditions as a single unfitting 
condition rated as 5099-5003 (analogous to arthritis) at 0%. The PEB relied on AR 635.40 (B.24 
f.) and/or the USAPDA pain policy for not applying separately compensable Veterans 
Administration Schedule for Rating Disabilities (VASRD) codes. The Board must apply separate 
codes and ratings in its recommendations if compensable ratings for each condition are 
achieved IAW VASRD rating guidelines. If the Board judges that two or more separate ratings 
are warranted in such cases, however, it must satisfy the requirement that each ‘unbundled’ 
condition was unfitting in and of itself. Thus the Board must exercise the prerogative of 
separate fitness recommendations in this circumstance, with the caveat that its 
recommendations may not produce a lower combined rating than that of the PEB. 

 

Bilateral Foot Pain. The narrative summary (NARSUM) which was undated, but took place in 
September 2002 and was authored by the CI’s treating podiatrist, notes the CI had a history of 
foot pain that began in 1996. He eventually underwent bilateral hammertoe correction, and 
plantar fascia release surgeries. When his pain was not improved he had a magnetic resonance 
imaging (MRI) exam and electromyography (EMG) of both feet done, which supported the 
diagnosis of bilateral tarsal tunnel syndrome, a compressive neuropathy of the foot. The CI had 
tarsal tunnel release of both feet, approximately 18 months prior to separation. He had 
persistent pain in his feet postoperatively, stating that he felt about the same with pain on 
standing and with activity and was referred to pain management. Repeat EMG showed distal 
posterior tibial nerve latencies were prolonged bilaterally as had been noted on the prior EMG 
of 4 April 2001. Additional conservative treatment failed to improve the CI’s pain sufficiently 
for return to full duty. 

 

At the MEB exam September 2002, approximately 7 months prior to separation, the CI reported 
constant bilateral foot pain on the bottom of both feet for years. He noted the best treatment 
was to remain off his feet as much as possible and that he used a wheel chair for trips to the 
stores. The MEB exam noted normal skin except for well healed, non-tender surgical scars, and 
normal vasculature of the feet, without discoloration or ulcers. Muscle strength and range-of-
motion (ROM) were within normal. There was no laxity, muscle atrophy, no painful metatarsal 
heads or capsulitis. There was no pes cavus, pes planus, flexion contractures, Haglund’s 
deformity, first metatarsal joint crepitus or other arthritis. Deep tendon reflexes (DTRs) were 
normal and no “history of pain, paresthesia, burning…” There was hallux valgus bilaterally and 
heel pain was noted. There were no signs of nerve compression or tumors. There was mildly 
decreased sensation on the top of the right foot and ankle. Pain management notes in the 
service treatment record (STR) indicate that post tarsal tunnel release the CI continued with 
pain in both feet, rated at 6 to 7 out of 10 on the left and 9 out of 10 on the right. Despite a 
small improvement in the pain on medication, the CI could not tolerate the side effects and 
stopped them, and declined more invasive interventions. Examiner notes on the DD Form 2807 


state “Pt. continues to have pain both feet with numbness, tingling, and burning sensation 
affecting soles.” 

 

At the VA Compensation and Pension (C&P) exam on 28 March 2003, approximately 2 weeks 
after separation, the CI reported bilateral foot pain, rated five out of ten. No abnormality of 
posture and gait was noted. Examination of the feet showed the surgical scars. The examiner 
stated “All range of motion measurements were within normal limits.” Sensation was intact 
and motor strength and reflexes were described as “symmetrical in the lower extremities 
bilaterally.” X-rays of the feet were reported as showing surgical changes and fusion, but no 
significant abnormality. The VA examiner stated “Bilateral feet-status post surgical changes 
with no functional loss of ROM due to pain.” 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB bundled the bilateral foot pain condition as one unfitting condition and rated as 5099-5003 
at 0% and cited the USAPDA pain policy. The VA rated each foot separately as 8721-5283 
(analogously to neuropathy of the common peroneal nerve with metatarsal malunion or 
nonunion). The Board next undertook to unbundle the bilateral foot conditions. The CI had a 
longstanding history of bilateral foot pain, with three associated surgeries of each foot, and 
persistent pain in both feet noted in the STR after the last surgeries for tarsal tunnel release. 
The permanent profile noted only “Post-op tarsal tunnel release with neuropathy”. Repeat 
EMG performed after the tarsal tunnel surgeries remained abnormal in both feet. The 
commander’s statement states that due to the CI’s restrictions of no running, marching or 
standing more than ten minutes status post tarsal tunnel release with neuropathy, the CI was 
unable to perform the required duties of his MOS or satisfy Army Physical Fitness Test 
requirements. The Board agreed that each foot was separately unfitting. The Board 
deliberated rating the foot conditions as posterior tibial nerve (tarsal tunnel) 8525 (neuropathy) 
versus as 8625 (neuritis) or 8725 (neuralgia). The MEB and VA exams both noted the CI had 
normal reflexes and muscle strength. The ROM of both feet and ankles was noted to be normal 
at the VA exam and was described as within normal at the MEB exam by the CI’s treating 
podiatrist. At the MEB exam, decreased sensation was noted on a limited area of the right foot 
and ankle. At the VA exam bilateral foot sensation was noted to be normal. The Board agreed 
that evaluation IAW §4.124 (neuralgia, cranial or peripheral) was the most appropriate fit to the 
CI’s clinical condition and that under 8725 (neuralgia, posterior tibial nerve) the highest rating 
that can be achieved is 10%. The Board could find no pathway to a higher rating. The Board 
deliberated whether the right and left foot met the 10% rating. The Board considered the 
normal findings of the feet at both the MEB and C&P exams discussed above and there was no 
evidence in the record to support that the findings in one foot were more significant than the 
other at separation. Therefore, the Board opined that neither the right nor the left foot met 
the 10% rating of 8725. Having unbundled the bilateral foot pain condition, the Board found 
there was no benefit to the service member. Therefore, after due deliberation, considering all 
of the evidence and mindful of VASRD §4.3 (reasonable doubt) and IAW 4.31 (0% evaluations), 
the Board majority concluded that there was insufficient cause to recommend a change in the 
PEB adjudication for the bilateral foot pain 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 bilateral foot pain conditions was operant in 
this case and the conditions were adjudicated independently of that policy by the Board. In the 
matter of the bilateral foot condition and IAW VASRD §4.71a, the Board, by a vote of 2:1, 
recommends no change in the PEB adjudication. The dissenting vote recommended a disability 
rating as follows: an unfitting right foot at 10% and an unfitting left foot at 10%, both coded 


8725 IAW 4.124a. There were no other conditions within the Board’s scope of review for 
consideration. 

 

 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Bilateral Foot Pain Condition 

5099-5003 

0% 

COMBINED 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120914, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxx, AR20130009513 (PD201201845) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards) 

 

 

 


MINORITY OPINION: 

 

The minority voter opines that the CI had persistent bilateral nerve related pain and slight 
sensory dysfunction and paresthesias, without any weakness, permanent sensory loss, or 
abnormal reflexes. Coding with 8725 rating each foot at 10% for mild to moderate neuralgia 
IAW 4.124a is consistent with bilateral foot pain and paresthesia symptoms and therefore the 
CI does meet the 10% rating for each foot. 

 

The issue in this case is the assessment of the amount of disability resulting from bilateral 
neuralgia that was a residual of the bilateral tarsal tunnel syndrome. The CI had a long history 
of foot problems and surgeries. He was diagnosed by EMG and MRI to have bilateral tarsal 
tunnel syndrome. The CI had tarsal tunnel release (TTR) surgeries on both feet in July (L) and 
September (R) 2001, which temporarily improved his pain, but symptoms recurred within 
several weeks. A repeat EMG demonstrated persistent abnormalities, unchanged from the pre-
operative findings. 

 

On the podiatry follow-up visit 20 September 2001 the CI reported that the right foot felt about 
the same. 

 

On 18 October 2001 follow-up visit the CI reported recurrent pain with standing and activity 
and was referred for pain management. 

 

At the 7 January 2002 pain management evaluation the CI reported bilateral foot pain that was 
a constant, dull ache that increased to burning and sharp with prolonged standing or walking. 
On exam he had a non-antalgic gait, full ROM, intact reflexes, with patchy numbness of the 
soles of his feet. 

 

On the 1 March 2002 visit the CI reported the pain was worsening, rated as 6/10, that increased 
to 9/10 with activity of standing or walking, and numbness and tingling in the soles of his feet. 
He denied any weakness. On exam the varying and patchy numbness of the soles of his feet 
was again noted as well as numbness of the right heel. 

 

He was tried on medications for nerve related symptoms, one of which was modestly helpful, 
but he did not like the side effects and stopped them. He was offered other pain management 
interventions that he declined. 

 

The minority voter recommends the CI’s persistent bilateral nerve related pain and slight 
sensory dysfunction and paresthesias be modified as follows: 8725 rating each foot at 10% for 
mild to moderate neuralgia IAW 4.124a. The following is respectfully recommended: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Right Foot Pain Condition 

8725 

10% 

Left Foot Pain Condition 

8725 

10% 

COMBINED (w/ BLF) 

20%