Search Decisions

Decision Text

AF | PDBR | CY2013 | PD2013 02512
Original file (PD2013 02512.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1302512
BRANCH OF SERVICE: Army  BOARD DATE: 20140729
SEPARATION DATE: 20051227


SUMMARY OF CASE: T he available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (13B30/Cannon Crewmember) medically separated for feet pain . The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards. The CI was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The feet condition, characterized as “ bilateral pes planus , ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “ c hronic bilateral foot pain ” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I was told that I could no longer serve because of my feet and I would be medical boarded. I tried 100% for 8 years to make the Army my career including 13 months in Iraq just to get put of with 10% rating as a SSG/E-6 after all those years.”


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 feet condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 ratable severity at the time of separation and to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation. 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 Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20051209
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Bilateral Foot Pain 5299-5276 10% Bilateral Pes Planus, w ith Plantar Fasciitis 5299-5276 10% 20060203
No Additional Conditions in Scope
 No Other VA Conditions in Scope
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70329 .





ANALYSIS SUMMARY:

Bilateral Foot Condi tion. Absent direct acute trauma, the CI began having bilateral foot pain approximately 12 months after entering the military. Initially he received limited conservative treatment and for years, he simply “…ignored his problems and did his duties as directed.” His foot pain slowly worsened and failed treatment modalities to include, custom orthotics, physical therapy (PT), stretching exercises, medications, and multiple restricted profiles. Podiatry consultation noted bilateral decreased arch with medial bulging upon weight-bearing. His diagnosis was severe, bilateral pes planus (flat feet) and was referred for an MEB. Plain film X-rays revealed the same. The service treatment record contained very few source documents in regards to the bilateral foot condition and most of the historical information was gathered in summary reports. Both feet appeared equally symptomatic. At the NARSUM examination (7 weeks prior to separation), the CI reported bilateral foot pain with more than mild walking, prolonged standing, or any active use particularly if weight-bearing is involved. Additionally, he is unable to perform a heel-walk due to pain. His examination was brief and revealed bilateral flattening of his arches with normal appearing mobility of the foot joints. There was no comment with regards to abnormal callous formation. His prognosis was an expectation of continued discomfort if there is ongoing prolonged standing, marching, or excessive use. His permanent profile reflected many physical limitations and the commander’s statement cited the inability to perform many physical exercises and activities.

At the VA Compensation and Pension (C&P) examination (6 weeks after separation) the CI reported intermittent times of experiencing bilateral foot pain and indicated that the condition has “improved” since military discharge in response to performing less activities. On examination, his gait was normal and loss of arch when standing was identified. Plain film X-rays taken as part of the C&P noted, “…there is no evidence of pes planus”; however, it also noted that the said X-ray was not a standing lateral view that is normally obtained in looking for a flat foot condition. The diagnosis was “mil” pes planus with the addition of plantar fasciitis. His functional impact was described as decreased mobility, carrying and lifting problems, and requires modified footwear.

The Board directs its attention to its rating recommendations based on the evidence just described. As previously elaborated, the PEB bundled the chronic bilateral foot pain at 10% using an analogous 5276 code (flatfoot; acquired). The VA also bundled the foot condition with an additional diagnosis of plantar fasciitis utilizing the same coding scheme and rating as the Service. The Board first considered if a combined bilateral rating was appropriate and the most favorable rating IAW VASRD §4.7 (higher of two evaluations). The clinical pathology and examination findings clearly indicate that the 5276 flat foot code was appropriate. In consideration of separate ratings, the Board must also consider separate fitness assessments which justify each disability rating. Separate ratings were considered under analogous 5299-5284 (foot injuries, other), which is the only available unilateral coding option applicable to the case. All members agreed, however, that the clinical presentation was solidly aligned with code 5276 which provides for bilateral ratings and furthermore, neither single foot could be reasonably justified as separately unfitting as is requisite for rating. The Board further considered if the bilateral 30% rating under 5276 could be supported. This is for "severe" impairment associated with "marked deformity", "pain on manipulation and use accentuated", and "characteristic callosities" and members agreed that the 30% criteria were not adequately supported. Both feet were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement and both were profiled. Board members concurred therefore that each foot should be conceded as separately unfitting and that coding and rating features were logically identical. Board members agreed that evidence does not support a conclusion that each foot separately, as an isolated condition, would have rendered the CI incapable of continued service within his MOS and, accordingly cannot recommend separate impairment ratings. The 5276 code allows for either a unilateral or bilateral rating of 10% for “pain on manipulation and use of the feet,” which was identified in this case. In the absence of any orthopedic joint abnormality, there are no other optimal coding fits under VASRD §4.71a. The criteria for higher ratings under code 5276 rest heavily on the anatomic deformities associated with pes planus which were not present in this case. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB’s 10% rating.


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 chronic bilateral foot pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication at separation.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131110, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX , AR20140018962 (PD201302512)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2011 | PD2011-01102

    Original file (PD2011-01102.docx) Auto-classification: Approved

    The PEB adjudicated the bilateral, plantar fasciitis and bilateral flat feet conditions as unfitting, rated 0%, with application of the U.S. Army Physical Disability Agency (USAPDA) pain policy. It noted the progression of the bilateral foot pain despite conservative treatment and limitation of activities; “currently, her feet still hurt and she is not doing any high impact activities but the pain is starting to increase.” The examination documented bilateral pes planus and tenderness on...

  • AF | PDBR | CY2013 | PD-2013-01298

    Original file (PD-2013-01298.rtf) Auto-classification: Approved

    CI CONTENTION : “I was found unfit for the Army for the medical condition Bilateral Plantar Fasciitis with slight pes planus. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Bilateral Foot Pain with Plantar Fasciitis5399-53100%Bilateral Plantar Fasciitis with Slight Pes Planus and Slight Hallux Valgus5299-527610%20050110Other x 0 (Not in Scope)Other x 9 (Not in Scope)20050110 Combined: 0%Combined: 20%*Derived from VA Rating Decision (VARD)dated 20050311 ( most proximate to date...

  • AF | PDBR | CY2009 | PD2009-00707

    Original file (PD2009-00707.docx) Auto-classification: Denied

    The VA considered the CI’s foot conditions (Bilateral Plantar Fasciitis with Pes Planus) as combining for foot disability IAW VASRD §4.71a-29 using rating Code 5276 Flatfoot; acquired and awarded the CI with a rating of 30% (severe, bilateral). The Board considered the overlap of foot symptoms from the two inter-related conditions (Plantar Fasciitis and Pes Planus) and rating as a single bilateral code of 5276 at 30% (severe, bilateral) as the VA rated the combined foot conditions. After...

  • AF | PDBR | CY2013 | PD2013 00147

    Original file (PD2013 00147.rtf) Auto-classification: Denied

    CI CONTENTION : “I had four different surgical procedures done by the Army on both feet which has resulted in continued pain, callouses and deformity of my toes in addition as a result of my military service. The examination was based on her evaluation on 28 October 2003. Physical Disability Board of Review

  • AF | PDBR | CY2014 | PD-2014-01985

    Original file (PD-2014-01985.rtf) Auto-classification: Denied

    According to the VASRD rules for rating the spine in effect at the time of separation thoracic and lumbar spine conditions coded IAW §4.71a are provided a single disability rating and thus the thoracic DDD and the lumbago (listed by the PEB as separate conditions) are subsumed in the §4.71a rating that follows. Since the disability due only to the left foot cannot be isolated by the clinical evidence or from the fitness implications of the bilateral condition, the Board consensus was that...

  • AF | PDBR | CY2013 | PD-2013-02184

    Original file (PD-2013-02184.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Plantar Fasciitis5399-53100%Pes Planus With Plantar Fasciitis, Bilateral527610%20010604*Other x 0 (Not in Scope)Other x 0 Rating: 0%Rating: 10%Derived from VA Rating Decision (VARD)dated 20020118 ( most proximate to date of separation [DOS]). The Board concluded the evidence supported the minimal compensable rating under §4.40 (functional loss), coded 5299-5276.After due deliberation, considering all of the evidence...

  • AF | PDBR | CY2011 | PD2011-00720

    Original file (PD2011-00720.docx) Auto-classification: Denied

    The PEB adjudicated the bilateral foot pain condition as unfitting, rated 20% (combined 10% left and 10% right) with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Bilateral Foot Pain Condition . The VA coded the feet condition as flat feet and synovitis (5276-5020) rating each foot at 10%.

  • AF | PDBR | CY2013 | PD-2013-01841

    Original file (PD-2013-01841.rtf) Auto-classification: Approved

    No other conditions were submitted by the MEB.The Informal PEB (IPEB) adjudicated the right anterior knee pain as unfitting, rated 0%IAW the VA Schedule for Rating Disabilities (VASRD); the pes planus and secondary plantar fasciitis was determined to have existed prior to service, were not permanently service aggravated and therefore not compensable. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Right Anterior Knee Pain5099-50030%Residuals, Right Knee Injury 526010%20060119Pes...

  • AF | PDBR | CY2014 | PD-2014-00091

    Original file (PD-2014-00091.rtf) Auto-classification: Approved

    The left foot conditions, characterized as “symptomatic pes planus on the left foot” and “left plantar fasciitis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Plantar Fasciitis Left Foot w/ Congenital Pes Planus5399-53100%Left Foot Plantar Fasciitis and Pes Planus52760%*20060102Other x1 (Not in Scope)Other x7 Combined: 0%Combined: 40%Derived from VA Rating Decision (VARD)dated 20060410(most proximate to date...

  • AF | PDBR | CY2013 | PD-2013-02199

    Original file (PD-2013-02199.rtf) Auto-classification: Approved

    The CI appealed to the Formal PEB (FPEB), which conceded service aggravation, and rated the bilateral plantar fasciitis at 0%, citing criteria of the Veterans’ Affairs Schedule for Rating Disabilities (VASRD).The remaining conditions were determined to be not unfitting (by the IPEB and FPEB). The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities...