RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00645
BRANCH OF SERVICE:  Army	BOARD DATE:  20141203
SEPARATION DATE:  20040813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (46Q/Photo Journalist) medically separated for plantar fasciitis.  The foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “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 secondary to plantar fasciitis” as unfitting, rated at 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “The condition for which I received my medical discharge keeps recurring. The plantar fasciitis comes back everytime I have taken work which requires me to be on my feet. At its worst, it has affected my ability to work full time and even reteining [sic] employment.” 

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 plantar fasciitis condition is addressed below and 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 20040604 	VA  (~6 mos Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain sec. to Plantar Fasciitis	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5279	10%	20050201	
Other x 0  (Not in Scope)	Other x 1 	
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20060622 (most proximate to date of separation)

ANALYSIS SUMMARY:

Chronic Bilateral foot pain/ Plantar Fasciitis.  The treatment record noted the CI reported non-traumatic pain in his left heel in May 2002 diagnosed as plantar fasciitis.  He was treated conservatively with non-steroidal anti-inflammatories, arch support, night splints, and exercises with minimal improvement.  He underwent consultations with physical therapy, orthopedics, and podiatry.  Left foot radiographs dated 28 November 2002 demonstrated a normal foot.  During the podiatry evaluation on 24 April 2003 recorded the CI had pain in the left heel that was present in the morning and after rest.  Examination of the foot noted tenderness to palpation in the posterior medial tubercle (calcaneal-heel bone) and no evidence of neurological or vascular compromise, or inflammation.  Pain was absent in the posterior heel area.  In February 2004 a permanent profile was initiated by primary care that noted the CI desired to remain on active duty.  The profile restricted running, and allowed unlimited walking, biking and swimming, for the condition of plantar fasciitis (did not specify left foot or bilateral condition).  There were no treatment records in evidence that recorded a right foot condition, and no documented right foot pain complaint.  

During the MEB narrative summary (NARSUM) performed on 27 April 2004, the physician noted the CI subsequently developed bilateral plantar fasciitis, and had received injection treatments after more conservative treatment approaches had minimal effect.  However, his pain continued and he was referred to the MEB process.  The CI was not able to conduct daily physical training with his unit or complete work assignments.  Physical examination recorded height of 72 inches and weight of 207 pounds.  He was in no apparent distress.  Gait was not recorded.  Examination of the extremities demonstrated tenderness to palpation, bilateral feet, in the anterior to the calcaneal area; otherwise an unremarkable examination.  Motor strength, sensation, and reflexes were all intact.  The examiner noted his condition was stable, but chronic, and had not improved with treatment.  

At the VA compensation and pension (C&P) evaluation performed on 1 February 2005 (approximately 5 months after separation), the CI claimed the condition of bilateral plantar fasciitis and reportedly stated his right foot was worse than the left.  His right foot pain preceded his left foot pain (inconsistent with records).  The pain was greater when he ran, walked or stood for long periods of time.  He had pain at rest rated as two out of ten.  Pain intensity during prolonged standing, walking or running was four out of ten.  Physical examination recorded abnormal gait; he limped off and on, but did not use any assistive device for ambulation.  On physical examination, the examiner noted both feet were normal in contour and symmetrical in form and function, and no evidence of weight bearing issues.  There were no calluses indicating unusual pressure point, additionally, there was no evidence of inflammation, tenderness, instability or lack of endurance.  There was no deformity of the toes and no sensory or vascular abnormality.  Painful motion of the feet and toes, and tenderness were noted in the instep bilaterally, and there was no evidence of feet deformity.  Ankle ranges-of-motion measurements were normal and pain was not present.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the foot condition recorded as chronic bilateral foot pain secondary to plantar fasciitis, rated analogously coded 5399-5310 (Group X) muscle injury at 0% for slight.  The VA rated the condition at 10% coded analogously 5299-5279.  The Board first considered if each foot could be reasonably justified as separately unfitting.  The Board noted there were no entries in the treatment record that addressed his right foot; however, the condition was recognized at the MEB and opined to be unfitting without reference to one foot being worse than the other.  The Board determined the record in evidence did not reasonably support that either foot were separately unfitting; however, taken in combination, the condition was unfitting.  The Board agreed separate ratings were not supported by the evidence at hand.  A 10% evaluation under the code 5310 requires objective evidence of moderate impairment involving movement of feet or toes due to muscle dysfunction or plantar fascia/ligaments.  The available evidence does not support a higher rating under this code.  The Board noted the only clinical finding was bilateral tenderness, recorded at both C&P and MEB examination and the absence of pain on motion at the NARSUM.  The Board noted code 5276 (flatfoot) was not applicable since the CI had a normal arch, and the 5279 code (metatarsalgia, anterior) was not supported by the evidence.  There were no additional coding options applicable to the rating of this condition.  The Board deliberated the application of VASRD § 4.40 and §4.59 and agreed the record did not sufficiently document the condition was compensable under either provision since the record in evidence demonstrated no loss of function and no evidence of painful motion resulting in functional impairment.  He was able to snowboard.  Thereupon, 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 foot 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 Chronic Bilateral Foot Pain condition and IAW VASRD §4.71a, 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 20140130, 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 XXXXXXXXXXXXXXXXX, AR20150007101 (PD201400645)

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