RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01028
BRANCH OF SERVICE:  Army	BOARD DATE:  20150319
Separation Date:  20070105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Fire Support Specialist) medically separated for left foot plantar fasciitis.  The left foot condition could not be adequately rehabilitated to meet the physical requirements of Basic Training.  His profile allowed for alternate aerobic events to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left plantar fasciitis condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated left foot plantar fasciitis as unfitting, rated 0% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The VA rated me at 10%.  I still have pain and discomfort in this foot.  The foot also limits what activities I am able to do.”

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 20061213	VA - (3 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Plantar Fasciitis	5399-5310	0%	Left Foot Plantar Fasciitis	5299-5276	0%	20070303	
Other x0	Other x1	
Combined:  0%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20070723 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him.  It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  This role and authority is granted by Department of Veterans Affairs.  The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation.  Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Left Foot Plantar Fasciitis Condition.  The CI developed left foot pain during a road march on 6 July 2006.  The Medical Clinic provider documented that the CI reported pain in the anterior dorsum of the left foot with physical exam findings of left foot navicular region (dorsum) tenderness to palpation (TTP).  The CI was referred to physical therapy for plantar fasciitis of the left foot.  The CI reported left foot tightness, 7/10 pain with gait especially after a run or long road march.  The physical therapist noted 4/10 pain standing on the left lower extremity along with a hand resting on the wall for balance, positive metatarsal squeeze test; TTP over middle and distal portions of the left plantar fascia, TTP over navicular area; significantly decreased range-of-motion with dorsal flexion and plantar flexion.  The Medical clinic provider continued to note left foot painful motion and TTP on the instep.  The Bone Scan of the left foot demonstrated a stress reaction of the feet.  The commander’s statement indicated that while the CI was a good soldier, his physical condition created a burden for others in his unit and adversely impacted morale and readiness.  The MEB narrative summary exam a month prior to separation documented that there was no significant improvement with PT.  There were physical findings of normal gait, left foot TTP of the instep; intact sensation and light touch were normal.  The examiner made the following concluding statements:

“However, he would not be able to perform marching or prolonged walking and will have an especially difficult time traversing uneven terrain.  He would be unable to ruck march.  Physical training activities, which he is unable to perform, includes activities involving running and jumping.  The patient is able to perform the basic activities of daily living, but no longer runs for fitness or pleasure.  The patient is concerned about being able to obtain employment in the civilian environment due to difficulty with prolonged standing.”

The VA Compensation and Pension exam 2 months after separation documented daily moderate left foot pain with a fair response that had progressively worsened.  The CI complained of pain in the plantar surface of the left foot while standing, walking and at rest.  The physical exam was essentially normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the left foot plantar fasciitis condition as 5399 analogous to 5310 (Group X muscle injury; function: Movements of forefoot and toes; propulsion thrust in walking; Intrinsic muscles of the foot) and rated at 0% citing “rated as slight.”  That rating was consistent with VASRD rating guidelines.  The VA coded the left foot plantar fasciitis condition as 5299 analogous to 5276 (Flatfoot, acquired: [pes planus]) and initially rated it 0% which was increased to 10% effective 13 months after separation.  The MEB examiner documented left foot pain with activity as slight.  Board members agree that plantar fasciitis was the correct diagnosis and that that condition is more appropriately rated under VASRD code 5310 as applied by the PEB.  The VASRD rating guidelines for code 5310 require a subjective estimate of impairment as “severe,” “moderately severe,” “moderate” or “slight.”  The evidence supports that the CI could not continue training and had function limiting pain that was refractory to extensive therapy.  Bone scan results indicated that there was increased stress reaction of the left foot.  While there was no evidence supporting the severe or moderately severe rating criteria (no surgery, injections, or limitation of activities of daily living) the level of impairment did meet the subjective criteria of moderate.  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 foot 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 left foot plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 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:

CONDITION	VASRD CODE	RATING	
Left Foot Plantar Fasciitis	5310	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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, AR20150013321 (PD201401028)

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						     XXXXXXXXXXXXXXX										     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA