RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01318
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E1, Fire Support Specialist, medically separated for “foot injuries, other,” with a disability rating of 10%.  

CI CONTENTION:  The applicant states he was not evaluated for his PTSD or TBI conditions.  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 - Dated 20090326	VARD - 20090814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Foot Injuries, Other (Plantar Fasciitis, Left Foot)	5299-5284	10%	Left Heel Spur	5099-5015	0%	20090427	
			Left Foot Plantar Fasciitis and Pes Planus	5299-5276	0%		
			Left Heel Fracture	5299-5284	NSC		
Headaches	Not Unfitting	Head Injury/Concussion	8045	NSC		
		Post Concussion Headache	8045-8100	NSC		
COMBIEND RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Foot Injuries, Other (Plantar Fasciitis, Left Foot).  The Medical Evaluation Board narrative summary (NARSUM) was accomplished on 23 February 2009, approximately 4 months before separation.  It noted that while in Iraq on foot patrol, the CI noticed pain in his left heel, present in standing and walking that occurred intermittently.   The pain was of aching character, and soon became continuous. He was evaluated by podiatry and diagnosed with left foot plantar fasciitis.  Conservative treatment provided limited benefit.  Radiographs documented plantar calcaneal spur without evidence of fracture, and surgery was offered but the CI declined.  At the NARSUM, the CI reported that he continued to have pain in his left heel without any specific injury.  He described his pain as chronic of an intensity of 6/10 which increased to 8/10 with activity.  He was not taking any medication.  The examiner documented the physical exam that was performed 3 days earlier with finding of tenderness of the right heel and no other abnormalities.  His profile restricted running, jumping, heavy lifting, unlimited walking, rucking or wearing chemical gear.  The diagnosis of plantar fasciitis was recorded.

The VA Compensation and Pension (C&P) exam was conducted approximately 2 months before separation.  The CI noted that he had daily left foot pain lasting all day.  The pain was in his arches and his heel.  He used orthotics since September 2008 with minimal improvement.  Flare ups occurred with long walks and prolonged standing.  The examiner documented there were no effect on his daily activities or work and no missed days of work in the past 12 months.  Physical examination noted a normal gait.  He had no difficulty rising from a chair and did not use any supportive devices for ambulation.  Examination of the left foot noted pes planus and tenderness over the posterior heel on the sole of the foot.  He had normal alignment of the Achilles tendon and no signs of abnormal weight-bearing.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of left foot plantar fasciitis at 10%, coded analogously 5299-5284 (foot injury, other) for moderate impairment.  The VA rated the condition at 0% coded analogously 5299-5276 (flatfoot, acquired). A 20% evaluation under the code 5284 requires objective evidence of moderately severe impairment.  The Board noted the absence of weight-bearing issues, incapacitating episodes, and use of supportive devices.  Both the NARSUM and C&P exams recorded absence of prescribed medication use.  All Board members agreed there was insufficient evidence to support a rating higher than 10% under any applicable code.  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 left foot plantar fasciitis condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the CI’s headache condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The Board reviewed the available treatment records and found no evidence of treatment for a headache condition.  The record demonstrated that the CI underwent a traumatic brain injury (TBI) questionnaire in March 2008 in which he indicated that he had not sustained any head injuries from his deployment.  He noted he had no loss of consciousness, or symptoms of a concussion.  The NARSUM documented the CI reported occasional headaches since late deployment that lasted 5-10 minutes, 2-3 times per week with no aura and no associated symptoms.  The headache condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.     There was no performance based evidence from the record that his headache condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the Left Foot Plantar Fasciitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended headache condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160006672 (PD201401318)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA