RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01057
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E5, Military Policeman, medically separated for “bilateral foot pain,” with a disability rating of 10%. 

CI CONTENTION:  His condition was underestimated and continues to worsen and negatively impact his daily activities.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20090902	VARD - 20100305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain	5299-5276	10%	Right Foot Peroneal Nerve Neuropathy	8722	10%	20091118	
			Left Foot Peroneal Nerve Neuropathy	8722	10%	20091118	
			Bilateral Pes Planus	5276	0%	20091118	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right plantar facial release in November 2008 and left plantar facial release in February 2009 for plantar fascial foot pain which begun in 2004. Post-operatively the CI initially reported pain resolution; however, with resumption of military activities the pain returned and progressively worsened.  At the time of the NARSUM examination dated 24 July 2009 the CI reported 3/10 bilateral foot pain at rest which increased to 8/10 with activity.  Physical examination showed pes planus, hindfoot valgus (heel angles away from the body), forefoot varus (angled towards the body), and exquisitely tender plantar fascia bilaterally.  The lower extremity neurologic examination was normal.  A diagnosis of bilateral plantar fasciitis with chronic foot pain was rendered.  

At the VA Compensation and Pension examination dated 18 November 2009 (a month before separation), the CI reported pain in the arch of the foot and heel bilaterally.  The pain was worse with physical activity.  The physical examination showed bilateral non painful surgical scars, a normal gait, evidence of abnormal weight bearing (callosities), and bilateral arch tenderness to palpation.  There was painful foot motion, pes planus, and moderate valgus and mal-alignment of the forefoot/mid-foot which could not be corrected with manipulation bilaterally.  The lower extremity neurologic examination demonstrated decrease sensation bilaterally over the medial longitudinal arches of both feet. The examiner noted that the CI wore corrective shoes for “severely fallen arches.”   A diagnosis of bilateral pes planus with peroneal nerve neuropathy status post bilateral plantar fascial release surgery was rendered.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain as a single unfitting condition at 10%, coded 5299-5276 (analogous to pes planus moderate).  The VA rated the each foot condition 10%, coded 8722 (peroneal nerve neuralgia) and the bilateral pes planus condition at 0%, coded 5276 (acquire, pes planus).  Although VASRD §4.71a permits a single rating for bilateral pes planus under code 5276, it allows separate ratings for separately compensable lower extremity conditions.  IAW DoDI 6040.44 if the PEB combined adjudication is not VASRD compliant, each condition subsumed under the single Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings. In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agree that each foot was separately unfitting and that identical coding and ratings were applicable.   The Board considered if the foot condition was moderate or moderately severe when considered under code 5284 (foot injuries, other).   The Board agreed that the foot examinations proximate to separation, detailed above, were consistent with a moderate foot injury supported by the presence of tenderness to palpation, callosities indicative of abnormal weight bearing, pes planus, and   abnormal forefoot and hindfoot angulations for a 10% rating for each foot rating under this code.   Board members agreed that the evidence did not support a moderately severe rating of 20% for each foot nor a 30% rating for severe bilateral pes planus.  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 each foot for the plantar fasciitis condition.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition, the Board unanimously determined that each foot could be reasonably justified as separately unfitting and recommends a disability rating of10%  for each foot coded 5299-5284 IAW VASRD §4.71a.  
There were no other conditions within the Board’s scope of review for consideration.  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	
Left Plantar Fasciitis	5299-5284	10%	
Right Plantar Fasciitis	5299-5284	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140215, 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 XXXXXXXXXXXXXXXXXX, AR20160005600 (PD201401057)

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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA