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AF | PDBR | CY2012 | PD2012 00818
Original file (PD2012 00818.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1200818   SEPARATION DATE: 20031021
BOARD DATE: 20130502


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (93P/Flight Operations Specialist), medically separated for chronic right foot pain. The CI has complained of right foot pain for quite a while. She reports no specific injury. She has had night resting splints that have given her some relief. She has tried inserts with some relief, but she is still is unable to walk a significant distance due to her pain. She has no history of a previous fracture. The chronic right foot pain condition could not be adequately rehabilitated and the CI did not improve adequately with treatment to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded right foot stress fractures for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic right foot pain condition as unfitting, rated 0% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 0% disability rating.
CI CONTENTION: “Separated from service due to medical review board.” The CI elaborated no specific contention in her application.


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. 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 20030708
 VA (~6 mos. Post-Separation) – All Effective Date 20031022
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Foot Pain 5022 0% Bilateral Plantar Fasciitis w/history of stress fractures of the feet 5299-5276 0% 20040406
Not Service-Connected x 2 20040406
Combined: 0%
 Combined: 0%
VARD 20100517 inc. to 10% .


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ANALYSIS SUMMARY :

Chronic Right Foot Pain Condition . The narrative summary (NARSUM) notes that the CI had a history of right foot pain wi thout specific injury. Notes in the service treatment record (STR) indicate that the CI had bilateral pes planus that existed prior to service (EPTS) and foot pain started during basic training. She was treated with orthotics, night splints, custom boots, and physical therapy. A magnetic resonance imaging ( MRI ) of the right foot showed no tendon injury, but suggested a bone bruise and a bone scan showed multiple right foot st ress fractures . She was given a walking cast on the right foot for several weeks and there was significant improvement in her symptoms , but the CI continued to report right greater than left foot pain. At the MEB exam, the CI reported right foot pain improved with orthotics but still causing difficulty with walking long distances. The MEB physical exam noted bilateral pes planus and a non-antalgic gait. Range - of - motio n (ROM) of the ankle/foot was dorsiflexion 25 degrees (normal 20 degrees ) and planter fasciitis 15 degrees (normal 45 degrees ) , and was without pain . There was tenderness to palpation (TTP) over the navicular area (stress fracture site) . There was n o TTP of the tendon s. Reflexes, sensation and skin were normal . The CI was able to stand on her toes, one foot at a time. X-rays showed bilateral pes planus on weightbearing. The MEB examiner, an orthopedic specialist, opined that when the CI could control her own activities her symptoms should resolve and the prognosis of a full recovery was good. On the SF 93 medical history form 2 June 2003 the CI noted that she was unable to run or walk long distances or stand up for more than 8 hours on a work day. At the VA Compensation and Pension (C&P) on 6 April 2004 , approximately 6 months after separation , the CI reported pain and stiffness of both feet with walking and standing for more than thirty minutes and that arch supports did not help her foot pain. The CI was noted to be employed in a retail store. The VA exam showed normal gait and posture. There was painful motion, weakness and tenderness of both feet noted on exam , with no exam detail provided. The examiner stated “pes planus is not present”. There was no evidence of abnormal weight bearing of either foot. Exam of all other joints and muscles was within normal limits . Weight-bearing and non-weight bearing X-rays of the r ight and left feet were normal. The examiner noted the there was no current diagnosis of s tress fracture of either foot.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB rated the chronic right foot pain as 5022 (periostitis) at 0%. The VA rated bilateral plantar fasciitis as 5299-5276 ( analogous to acquired flat foot) at 0% . The Board deliberated the rating of the CI’s chronic right foot pain. At the MEB exam t he CI continued with pain that was somewhat improved by orthotics but prevented her from walking long distances . The CI reported on the SF 93 medical history form that her foot pain prevented her from standing more than eight hours in a work day, running or walking long distances. At the C&P exam the CI had a normal gait and posture. The CI reported pain and stiffness standing and walking f or more than thirty minutes but was employed in a retail store. The B oard considered if the CI’s chronic right foot pain met the 10% rating of either 5022 or 5276 IAW VASRD §4.71a and concluded that it did not. Therefore, a fter 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 right 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 was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right foot condition, IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. 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
Chronic Right Foot Pain Condition 5022 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120607, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010366 (PD201200818)


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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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