RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20090329 

 
NAME:  XXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200402 
BOARD DATE:  20130206 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (21E10/Heavy  Construction  Equipment 
Operator),  medically  separated  for  bilateral  leg  pain.    The  CI  developed  an  episode  of  “legs 
giving  out”  in  January  2006.    These  symptoms  worsened  and  the  CI  underwent  a  Medical 
Evaluation Board (MEB) and then a Physical Evaluation Board (PEB) in October for bilateral tibial 
shaft stress reactions.  The CI was found fit for duty with recommendation for reclassification.  
The CI returned to his unit and underwent foot surgery for a Morton’s neuroma.  However, as 
post-operative activity increased, this caused the leg pain to worsen.  Despite non-steroidal anti 
inflammatory  drugs  (NSAIDS),  physical  therapy  (PT),  neurology  consults,  orthopedic  consults 
and  podiatry  consults,  the  CI  failed  to  meet  the  physical  requirements  of  his  Military 
Occupational Specialty (MOS) satisfy physical fitness standards.  He was issued a permanent L3 
Profile and referred for a MEB.  The MEB forwarded bilateral leg pain on DA Form 3947 to the 
PEB,  as  the  single  condition  for  PEB  adjudication.    The  PEB  adjudicated  the  bilateral  leg 
condition as unfitting, rated (10% for the left and 10% for the right) for a combined 20% with 
application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no 
appeals, and was medically separated with a 20% disability rating.   
 
 
CI  CONTENTION:    “Bilateral  leg  pain  (at  the  medial  malleus  and  also  posterior  tibiae)  has 
steadily  increased  since  symptoms  first  presented  themselves  in  winter  2005/2006.    The 
Morton’s Neuroma's and resulting excision also have become more painful; right foot starting 
in 2003 and left in 2006.  The training and daily missions carried out with my assigned units 
prolonged  and  ultimately  exacerbated  these  injuries,  and  despite  several  forms  of  pain 
management/treatment.”   
 
 
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 unfitting bilateral leg pain condition 
was  considered  to  include  the  contended  Morton’s  neuroma  (feet)  condition  and  meets  the 
criteria  prescribed  in  DoDI  6040.44  for  Board  purview,  and  both  are  accordingly  addressed 
below.  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 Board for the 
Correction of Military Records. 
 
 

RATING COMPARISON: 
 
Service IPEB – Dated 20081217 
Condition 

Code 

Bilateral Leg Pain 

5099-5003 

Rating 
10% 

Left 

Right 

10% 

No Additional MEB/PEB Entries↓ 
Combined:  20% 

Bilateral 

Tibialis 

VA (1 Mos. Pre-Separation) – All Effective Date 20090330 
Rating 
Condition 
Chronic 
10% 
Tendonosis 
Morton’s  Neuroma,  Bilateral 
Feet 
0% X 1 / Not Service-Connected x 2 
Combined:  20% 

Code 
5299-5276 

5279 

Exam 
20090313 

20090217 
20090217 

10% 

in  DoDI  6044.40,  however,  resides 

 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impairment  with  which  his  incurred  condition  continues  to  burden 
him.  It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor 
the  authority  to  compensate  members  for  anticipated  future  severity  or  potential 
complications of conditions resulting in medical separation.  This role and authority is granted 
by  Congress  to  the  Department  of  Veterans  Affairs  (DVA).    The  Board  utilizes  DVA  evidence 
proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-
month interval for special consideration to post-separation evidence.  The Board’s authority as 
defined 
in  evaluating  the  fairness  of  DES  fitness 
determinations  and  rating  decisions  for  disability  at  the  time  of  separation.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation.   
 
Bilateral Leg Pain Condition (Including Bilateral Tibial Tendonosis, Morton’s Neuroma, and Flat 
Feet).  The CI has a well documented history of bilateral leg pain in the service treatment record 
from February 1998 through October 2008.  He had right foot surgery in 2004.  The CI had a 
flare up of left hip and thigh pain and was prescribed an NSAID in 2005; however, left hip X-rays 
were  normal.    A  bone  scan  performed  in  March  2005  demonstrated  mild  stress  reaction 
changes  in  the  femurs,  knees,  tibial  shafts,  feet  and  ankles.    In  2006  the  CI  was  treated  for 
recurrent bilateral lower extremity pain with running and a documented history of shin splints 
which  required  PT  and  custom  aquaplast  orthotics.    In  2007,  the  CI  went  before  the  MOS 
Medical  Review  Board  who  recommended  reclassification.    The  CI  underwent  the  first  MEB 
exam for bilateral lower leg pain.  The PEB denied the reclassification request and found the CI 
fit for duty.  The CI was continued in his MOS.  After undergoing surgery for a left foot Morton’s 
neuroma in October 2007, the CI’s leg and foot symptoms increased.  CI noted pain, tenderness 
and burning on the left foot and the examiner noted sensory abnormalities.  The CI required 
custom feet orthotics to reduce the pain with ambulation.  A repeat scan of the lower legs was 
abnormal.  The CI was refit with a different custom orthotic to decrease bilateral leg and foot 
pain.  An electromyogram and neurology consult ruled out right foot tarsal tunnel syndrome.  In 
August 2008, the family practitioner noted that the CI complained of swelling and tenderness 
around  the  toes  of  the  left  foot  and  he  required  narcotic  medication  for  pain  relief.    The 
commander’s  statement  noted  that  the  CI  was  only  able  to  work  6  hours  per  day  due  to 
medication and his physical limitations and he required breaks throughout the day due to shin 
pain and swelling.   
 
The ankle, foot, and leg exams in evidence, with documentation of additional ratable criteria 
including goniometric range-of-motion (ROM) evaluations, which the Board weighed in arriving 
at its rating recommendation, are summarized in the chart below.   
 
 
 
 

   2                                                           PD1200402 
 

MEB ~5 Mo. Pre-Sep 

PT ~5 Mo. Pre-Sep 

VA C&P ~1 Mo. Pre-Sep 

Right 

Left 
“FROM in bilateral feet and 
ankles” 
Gait nml, “can toe and heel 
walk”;  motor 
sensory 
feet  bilat; 
intact; 
tenderness 
over 
distal 
medial 
(R>L),  and 
inferior  medial  malleolus 
(R>L) (see text) 

tibia 

flat 

Left 
5⁰ 
45⁰ 

Right 
3⁰ 
45⁰ 

*ROM for MEB exam; “Pain 
with 
for 
PROM” 

overpressure 

Right 

Left 
8⁰ bilaterally 
Not listed 
Tenderness 
along  posterior 
tibial  tendon;  subtalar  joint  2⁰ 
inversion, 4⁰ eversion bilat; TTP 
on  3  cm 
flatfoot; 
calcaneal  valgus  on  weight 
bearing;  toe  raises  intact;  left 
heel  inversion  with  toe  raise 
maneuver (see text) 
10% 
(VA 10% total) 

incision; 

10%  

Bilateral Ankle ROM 

Dorsiflexion (0-20⁰) 
Plantar Flexion (0-45⁰) 

Comment 

§4.71a Rating 

10% 

10% 

10% 

10% 

 
The MEB exam performed 5 months prior to separation indicated constant sharp pain in the 
medial lower legs which radiates down to the medial malleolus bilaterally worse in the right leg 
than the left; pain with walking upstairs and with driving 2 to 3 hours.  Physical exam findings 
are summarized in the chart above and the examiner indicated that: “Initial X-rays, bone scans, 
magnetic resonance imaging which showed “stress changes,” the more recent X-rays done on 
the  German  economy  were  normal.”    The  DD  Form  2808  also  noted  “tenderness  at  the 
insertion of the posterior tibialis tendon on the navicular bone” (mid-foot).   
 
The  VA  Compensation  &  Pension  (C&P)  examination  completed  a  month  prior  to  separation 
noted complaints of throbbing pain and swelling in both feet; functional limitations of standing 
approximately 20 minutes and walking approximately a mile; and that custom orthotics were 
required.  There were exam findings of tenderness along the distribution of the posterior tibial 
tendon bilaterally, tenderness along the incision lines of both feet, calcaneal valgus on weight 
bearing and left heel inversion with toe raise maneuver.  The C&P physical exam findings are 
summarized  in  the  chart  above.    Final  diagnoses  were  Morton’s  neuroma  bilateral  foot  and 
bilateral posterior tibial tendinosis. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB coded the bilateral leg pain condition analogously to arthritis (5099-5003 at 10% for each 
side) with application of the bilateral factor (BLF) for a rating of 20%.  The VA coded the chronic 
bilateral tibialis tendonosis condition 5299 analogous to 5276 flatfoot, acquired: (pes planus) 
rated  10%  and  additionally  coded  the  bilateral  Morton’s  neuroma  (feet)  condition  5279 
metatarsalgia, anterior (Morton’s disease, unilateral, or bilateral) rated as 10% (moderate).   
 
The  Board  discussed  the  issue  of  the  PEB’s  broad  diagnosis  of  “Bilateral  Leg  Pain”  with  a 
disability description that included “pes planus bilaterally;” as well as the statement that “There 
is no impairment of ROM, but he does have a constant pain in the medial lower legs radiating 
down to medial malleolus (ankle) bilaterally.”  Both the PT goniometric exam and the VA exam 
documented decreased dorsiflexion by goniometric measurements and were closer to the date 
of  separation.    Both  lower  legs  were  tender  and  demonstrated  painful  motion  on  the 
preponderance  of  exams.    The  MEB  exam  did  not  demonstrate  significant  mid  or distal  foot 
tenderness (although the narrative summary (NARSUM) indicated the prescription and use of 
custom orthotics), while the prior to separation VA exam indicated foot tenderness.  There was 
no arthritis or pathology of either ankle joint in evidence.   
 
The Board considered the PEB rating schema appropriately considered the tenants of VASRD 
§4.59  and  their  analogous  coding  was  acceptable  and  accounted  for  the  CI’s  bilateral  lower 
extremity disability.  Alternative coding using the VA rating separating the tendinosis from the 
Morton neuroma disabilities was also considered reasonable, but would also raise the military-

   3                                                           PD1200402 
 

specific issue of fitness when the NARSUM did not specify duty impairment from any mid, or 
distal  foot  condition.    The  Board  discussed  the  merits  of  adding  the  Morton’s  neuroma 
condition and using VA coding 5279 as a separately unfitting condition; however this would be 
considered pyramiding.  The bilateral leg pain condition could not be reasonably rated higher 
than a combined 20% using any exam proximate to separation or any alternate rating schema.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication for the bilateral leg 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.    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  bilateral  leg  pain  condition  (including  flat  feet  and 
Morton’s neuroma) and 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 
Bilateral Leg Pain; Left 
Bilateral Leg Pain; Right 

VASRD CODE  RATING 
5099-5003 
5099-5003 

10% 
10% 
COMBINED (w/ BLF)  20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120329, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200402 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXX, AR20130002823 (PD201200402) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

   5                                                           PD1200402