RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01750
BRANCH OF SERVICE:  Army	BOARD DATE:  20150116
SEPARATION DATE:  20040828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Specialist) medically separated for a bilateral foot condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty, but was authorized to perform an alternate physical fitness test (per PROFILE).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic plantar fasciitis bilaterally,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “bilateral plantar fasciitis, rated as moderate” as unfitting, rated 20% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI writes:  “bilateral plantar fasciitis migraines bronchitis.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

IPEB – Dated 20040407	VA* - (~3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	20%	Bilateral Plantar Fasciitis	5299-5276	20%	20040511	
Other x 0 (Not In Scope)	Other x 4 (Not In Scope)	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20040908 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis Condition.  The CI was seen for bilateral lower leg pain for several years after accession before she was first diagnosed with bilateral plantar fasciitis on 11 March 2003.  Over the course of the next year, she was treated with medications, shoe of comfort, duty restrictions, injections, and finally shock wave therapy, all without adequate relief of her pain sufficient to return to full duty.  She was issued an L3 profile and referred for an MEB.  The commander noted on 24 February 2004 that she could perform her duties in-garrison, but could not deploy.  The narrative summary was dated 10 March 2004, 5 months prior to separation.  The CI reported ongoing pain since basic training.  On examination, she was noted to have severe pain bilaterally at the insertion of the plantar fascia into the heel bone, but other abnormalities of the feet were not present.  Her X-rays were negative.  At the VA Compensation and Pension examination performed on 11 May 2004, 3 months prior to separation, the CI reported bilateral foot pain since March 2003 after running and marching a lot.  This is consistent with the contemporaneous records.  She used medications and inserts.  Activity was limited with walking no more than a mile or standing greater than 25 minutes.  She could not run; however, she could hop on one foot.  Her gait was normal.  She was tender as described above.  A bone scan showed mild, diffuse uptake bilaterally of the knees, ankles, and feet.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both awarded 20%.  The PEB coded the condition 5399-5310, analogous to (dysfunction of) muscles of the forefoot and toes, with the VA coding 5299-5276, analogous to flat feet (pes planus).  The Board observed that there is no specific code for plantar fasciitis in the VASRD.  It considered these codes and other options for the feet.  While the CI had bilateral tenderness at the insertion of the plantar fascia, her gait was normal, she was able to walk a mile, and had a normal examination other than pain.  The Board found no route to a rating higher than the 20% rating adjudicated by both the PEB and VA for the bilateral condition.  The Board noted that each foot was separately unfitting and would warrant a 10% rating; however, this provides no advantage to the CI.  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 of the bilateral plantar fasciitis 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 plantar fasciitis condition and IAW VASRD §4.71a and 4.73, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130919 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, AR20150009929 (PD201301750)

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		     
						         
CF: 
(  ) DoD PDBR
(  ) DVA