RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00454
BRANCH OF SERVICE:  Army	BOARD DATE:  20150408
SEPARATION DATE:  20040320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Air Defense C41 Tactical Operations Center Enhanced Operator Maintainer) medically separated for plantar fasciitis (PF).  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 left foot condition, characterized as “plantar fasciitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were forwarded by the MEB.  The Informal PEB adjudicated PF left foot as unfitting rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Increased pain.”

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:

Service IPEB – Dated 20040209	VA - (3.4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis Left Foot…	5299-5310	0%	Left Foot Plantar Fasciitis…	5310-5276	10%	20040630	
Other x 0 (Not in Scope)	Other x 1	
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20041103 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Foot Plantar Fasciitis.  The narrative summary notes the CI injured his left foot June 2002 during a road march with 60 pounds of gear.  The CI experienced pain and swelling of his left foot.  He was given crutches, a hard shoe, and medications for two weeks.  At a primary care visit on 2 August 2002 the CI reported left foot pain and exam noted tenderness to palpation (TTP) of the 2nd through 4th metatarsals.  Left foot X-rays on the same date noted a periosteal reaction of the second metatarsal (MT) consistent with a stress fracture.  No specific treatment notes follow that X-ray, but a note dated 31 January 2003 indicated foot pain for 7 months.  A bone scan performed on 5 February 2003, but noted no abnormal uptake in the left foot.  At a treatment visit on 4 August 2003 the CI reported re-injury of his left foot 3 months earlier with swelling and a limp.  He reported increased pain with weight bearing activities and noted sharp increased foot pain if he “stepped on wrong.”  He described the pain as located on the central bottom of his foot under the arch.  The exam noted full range-of-motion (ROM) with normal strength, no swelling or bruising, and pain with resisted eversion of the foot.  The examiner diagnosed PF and recommended stretches and alternate event for fitness test (APFT).  Repeat foot X-rays on 4 August 2003 were unchanged and the radiologist noted that the findings were consistent with either a normal variant or possibly a healing stress fracture of the second MT.  The DD Form 2808, Report of Medical Examination, on 11 December 2003 noted TTP of the bottom of left foot with a normal arch and no deformity.

At the MEB examination on 15 January 2004, 2 months prior to separation, the CI reported left foot pain that was unresponsive to orthotics, physical therapy, anti-inflammatory medications and limited activity.  He reported the pain was worse in the mornings or after periods of inactivity.  The MEB physical exam noted the CI had an antalgic gait.  There was TTP of the bottom of the foot near the heel without swelling.  Pulses and sensation of the foot were normal.  The examiner noted “functional ankle range of motion [ROM]” was dorsiflexion of 10 degrees (normal 20) and 60 degrees of PF (normal 45).

At the VA Compensation and Pension (C&P) exam performed, 3 months after separation, the CI reported continued problems with his left foot of daily pain, worse in the morning, somewhat improved later in the day, aggravated by weight bearing activities, without swelling or weakness.  He did not require the use of a cane or a crutch.  The exam noted a normal gait.  The appearance of the foot was normal with TTP of the left mid-foot.  There was no pain with manipulation and ankle ROM was full.  The examiner noted and agreed with the diagnosis of PF.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PF condition 0%, coded 5399-5310 (analogous to Group X muscle injury, analogous code used for PF) and the VA rated it 10%, coded 5310-5276 (acquired pes planus with muscle Group X injury).  The Board agreed that the evidence in record of daily left foot pain unrelieved by orthotics and aggravated by weight bearing with an antalgic gait at the MEB exam and TTP of the bottom of the foot at both the MEB and C&P exams met a 10% rating at the time of separation, coded according to 5276 criteria for pain on use of the foot unrelieved by orthotics or as 5279 (metatarsalgia).  The Board also agreed that the disability due to daily foot pain coded as 5399-5310 IAW §4.73 (muscle injuries) was better described as moderate for “consistent complaint of pain” of the plantar fascia than slight, which is characterized as injury with “healing with good functional results” and no cardinal signs or symptoms of associated disability.  The Board noted that a 10% rating could also be achieved with other applicable §4.71a codes, such as 5284 for other foot injury, moderate, but there was no evidence of severe flat foot, claw foot, malunion or nonunion of the tarsal or metatarsal bones, or “other foot injury” that could be characterized as “moderately severe” for higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left PF condition, coded 5399-5310.

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 left PF condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5310 IAW VASRD §4.73.  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	
Plantar Fasciitis, Left Foot	5399-5310	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141201, 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 XXXXXXXXXXXXXXXXXXXX, AR20150013223 (PD201400454)

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 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