RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01298
BRANCH OF SERVICE:  Army	BOARD DATE:  20141031
SEPARATION DATE:  20041021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92F/Petroleum Supply Specialist) medically separated for bilateral foot pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral foot pain condition, characterized as “chronic bilateral foot pain with plantar fasciitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic bilateral foot pain with plantar fasciitis” as unfitting, rated 0% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was found unfit for the Army for the medical condition Bilateral Plantar Fasciitis with slight pes planus.  When I put in various claims with the VA for service-connection I was awarded.” [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 rating for the unfitting bilateral foot pain 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 Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040819	VA - (3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain with Plantar Fasciitis	5399-5310	0%	Bilateral Plantar Fasciitis with Slight Pes Planus and Slight Hallux Valgus	5299-5276	10%	20050110	
Other 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 of separation [DOS]).  * VARD dated 20050719 added non-foot conditions with combined rating increased to 60% (without changes to rating for the feet).

ANALYSIS SUMMARY:

Bilateral Foot Pain.  The narrative summary notes a history of bilateral foot pain since 2000 which was not responsive to therapy including arch supports, custom orthotics, and ultrasound.  At the MEB exam, the CI reported pain in both arches and both heels with pain over 75% of the day and difficulty carrying heavy equipment or prolonged walking or running.  The MEB physical exam documented a slow normal gait with toe-walking without difficulty, but pain on heel-walking.  The ankles were stable with the range-of-motion decreased to 15 degrees (normal 20 degrees) and pain on the right heel and arch.  Neurovascular and motor exams of the feet were normal.  “There was tenderness to palpation along the medial plantar surface of the heel bilaterally and along the plantar surface of the arches bilaterally.”  Plain radiographs showed probable old fracture of the right ankle; bone scan documented “slight increased uptake in the mid foot on the right consistent with a stress related or gait related changes.”

At the VA Compensation and Pension exam performed approximately 3 months after separation, the CI reported pain in the bottom of both feet of 6-8/10 with pain on standing and walking with fatigability with repeated use of the foot.  Steroid injections, braces and inserts were noted to have helped.  The exam documented a normal gait with ''tenderness of the feet on the bottom of both feet from the heels to the arches to the forefoot, but not the toes.”  There were slight bilateral heel callosities (callus) with tenderness of the heels and slight flat foot (pes planus; right more than left).  Weight bearing alignment of the Achilles tendon was abnormal with heel valgus (outward slanting of heel) 5 degrees on each foot which could be corrected by manipulation (non-tender).  Slight (5 degrees) big toe non-tender angulation (hallux valgus) was noted on each foot.  Diagnoses were bilateral plantar fasciitis, bilateral slight pes planus and bilateral nontender slight hallux valgus.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the feet condition at 0% (“slight”) analogously to 5310 Group X muscle coding under VASRD §4.73 (Schedule of Ratings–Muscle Injuries).  The VA rated the feet condition(s) at 10% analogously to 5276 (flatfoot, acquired) under VASRD §4.71a (Schedule of Ratings–Musculoskeletal System).  Both the Service and VA exams were proximate to separation, and the VA exam was more detailed in describing the ratable criteria of the feet.  The key findings of tenderness of the foot were similar and the VA exam also documented the Achilles tendon misalignment and slight pes planus.  The rating differences between the PEB and VA appeared primarily based on the choice of analogous coding.  Plantar fasciitis is not specifically listed in the rating schedule; therefore, it is rated analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related.  The PEB rating using the muscle code followed the guidance from VASRD §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities) which would support a “slight” or 0% evaluation for each foot.  However, the VA rating under the musculoskeletal system is a reasonable analogous alternative and provides a higher rating given the CI’s examinations.

The Board adjudged that the CI’s foot symptoms were not relieved by orthotics and that the CI’s exams documented tenderness (pain) on manipulation and use of the feet was best described by the 10% rating criteria under the rating criteria of code 5276 for the bilateral foot condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board recommends a disability rating of 10% for the chronic bilateral foot pain with plantar fasciitis condition coded 5299-5276.

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 with plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Bilateral Foot Pain with Plantar Fasciitis	5299-5276	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130909, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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 XXXXXXXXXXXXXXX, AR20150003729 (PD201301298)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     

CF: 
(  ) DoD PDBR
(  ) DVA