RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD 13-00147	
BRANCH OF SERVICE:  Army  	 BOARD DATE:  20131011
SEPARATION DATE:  20040420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (73C / Military Pay Technician) medically separated for a bilateral foot condition.  She experienced the onset of bilateral foot pain in 1995, which worsened during an assignment in 2000 to Korea.  This was diagnosed as plantar fasciitis and was associated with pes planus.  Significant worsening of pain resulted in bilateral surgical repair for hammertoe deformities.  Her symptoms failed to respond to conservative measures using orthotics, and the condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral foot condition, characterized as “bilateral plantar fasciitis”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded bilateral pes planus existed prior to service (EPTS), iron deficiency anemia and headaches as not disqualifying. The informal PEB adjudicated “bilateral plantar fasciitis with physical exam noting pes planus” as unfitting, rated 0%, with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.

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.  I was exposed to 1B resulting in a potential to develop the disease which I was rated as non-condensable.  The constant pain and the deformity resulting from military surgery warrant a higher rating than 20%.”(sic)

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 Service rating for the unfitting bilateral foot condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 (BCMR).

RATING COMPARISON:  
   
Service IPEB – Dated 20040107	VA - (3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis w/Pes Planus	5099-5003	0%	Bilateral Plantar Fasciitis and S/P Hammertoe Correction	5276	10%	20040123	
Iron Deficiency Anemia	Not Disqualifying	No VA Entry	
Headaches	Not Disqualifying	Headaches	8100-8100	0%	20040123	
No Additional MEB/PEB Entries		20040123	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20040831 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  The Military Disability Evaluation System (MDES) is responsible for maintaining a fit and vital fighting force.  While the MDES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a service member’s career, and then only to the degree of severity present at the time of final disposition.  The MDES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service connected by the VA but not determined to be unfitting by the PEB.  However, the Department of Veteran Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the veteran’s disability rating should his degree of impairment vary over time.  The Board’s role is 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 severity at the time of separation.  

Bilateral Plantar Fasciitis w/Pes Planus Condition.  The CI reported that she started to have pain in her feet in 1995, several years after accession.  Conservative treatment was initially beneficial, but she then underwent resection of the head of the first joint of the left fifth toe for a hammertoe deformity.  She later had surgery of the second through fourth toes on the left in 2000.  She also had surgery on the right foot for hammertoes.  Despite additional surgery and duty restrictions, she could not meet the requirements of her MOS and was referred to MEB.  She was issued a permanent L3 profile for a history of left digital surgery and bilateral plantar fasciitis.  The Board noted that moderate, asymptomatic pes planus was noted on accession, but that the CI had over ten years of active service in the US Army.  The commander stated in the 20 October 2003 letter that she was profiled for both her toes as well as her plantar fasciitis.  She apparently did well in garrison, but could not meet all soldiering requirements.  The narrative summary (NARSUM) dated 26 November 2003, five months prior to separation, noted that no further surgical intervention was recommended.  She endorsed increased pain with weight bearing and impact activities.  The examination was based on her evaluation on 28 October 2003.  She was noted to have well healed surgical scars on both feet with minimal tenderness to palpation about digits 2-5 bilaterally.  There was mild tenderness to palpation of the plantar fascia bilaterally.  The range of motion was full and the neurovascular examination was normal.  Weight bearing x-rays were abnormal for the presence of pes planus and the previous surgery.  There were no acute abnormalities noted.  The pes planus was noted to have existed prior to service and to not be disqualifying.  The bilateral plantar fasciitis was disqualifying.  At the VA Compensation and Pension (C&P) examination performed on 23 January 2004, three months before separation, the CI reported that the foot condition does not interfere with her posture, gait, or restrict the footwear she uses.  She noted that her recreation was running and keeping busy with her children and that she could sustain heavy physical activities without immediate distress.  On examination, her posture and gait were normal.  The scars were noted to be well healed.  Movement was not compromised and there was no tenderness or instability noted.  Her arches were low.  She was thought to have recovered well from the prior surgery and to have bilateral pes planus with inactive plantar fasciitis.  X-rays of the feet with and without weight bearing showed a several bilateral pes planovalgus deformity of the feet, but were otherwise negative.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition, noting pes planus, analogously to degenerative arthritis using the code 5099-5003 at 0% disability.  The VA used the code 5276, flat feet, and rated the condition at 10%.  The Board considered the finding on the C&P that there was no tenderness on palpation of the feet which is consistent with the VA determination that the plantar fasciitis was inactive.  The Board also noted that the CI was able to be active with her children and listed running as a recreational hobby, but even though weight bearing had been problematic for years in the military.  The Board considered the code 5276, but determined that the evidence did not support a finding of greater than mild disability which rates at 0%.  After 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 bilateral plantar fasciitis with pes planus 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 condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the bilateral plantar fasciitis with pes planus condition and IAW VASRD §4.71a, the Board, by a vote of 2:1, recommends no change in the PEB adjudication.  The single voter for dissent (who recommended 10% coded 5276) did not elect to submit a minority opinion.  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 Plantar Fasciitis with Pes Planus	5099-5003	0%	
COMBINED	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120101, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXXX, AR20140000313 (PD201300147)

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