RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01621
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Light Wheeled Vehicle Mechanic, medically separated for “bilateral plantar fasciitis evaluated analogous to muscle injury Group X,” with a disability rating of 20%.

CI CONTENTION:  The CI contends that the VA discovered more extensive symptoms and diagnoses and that the Army rushed his disability processing.  The 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 - 20080814	VARD - 20100602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	20%	Plantar Fasciitis, Right Foot	5299-5276	20%	20100513	
			Plantar Fasciitis, Left Foot	5299-5276	0%	20100513	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented initial evaluation for left foot pain in September 2005 (3 years after service entry).  The CI received temporary profiles for bilateral feet in November 2007 and January 2008 (11 and 9 months prior to separation).  At a visit in March 2008 (7 months prior to separation), the CI presented for a temporary profile update, and reported 6/10 bilateral foot pain.  On the MEB DD Form 2807-1, Report of Medical History, dated 5 May 2008 (5 months prior to separation), the CI reported “feet swollen, hurts to walk, stand...”  On the MEB DD Form 2808, Report of Medical Examination, dated 14 May 2008 (5 months prior to separation), the examiner documented a normal exam of the feet and arches, annotated “symptomatic,” and further stated that the CI was using inserts and following recommendations for the bilateral condition.  In June 2008 (4 months prior to separation), the CI reported 4/10 bilateral foot pain with right worse than the left.  

The MEB NARSUM examination was performed on 19 July 2008 (3 months prior to separation).  The CI reported constant 4/10 pain in the bilateral arches and the plantar surface of the heel, that was worse (8/10) with running, jumping, road marches, and prolonged standing greater than 10 minutes.  The examiner documented a normal gait, with normal dorsiflexion and plantar flexion bilaterally with tenderness of the plantar surfaces of the bilateral heels and arches.  There were “good” arches, no visible swelling, and no painful motion.  

At the VA Compensation and Pension exam performed on 13 May 2010 (19 months after separation), the CI reported pain and swelling while standing and walking, inability to stand for more than a few minutes, and use of orthotics and a removable walking cast (CAM walker).  The examiner documented a limping gait with externally rotated feet bilaterally, and ambulation with a pair of crutches “trying to keep weight off of the right foot.”  There was “severe” bilateral tenderness at the medial plantar heel (plantar fascia insertion point) with “swelling and weakness” on the right.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition individually at 10% for the right and 10% for the left for a combined rating (using the bilateral factor) of 20%, analogously coded as 5399-5310 (muscle Group X function) citing bilateral plantar tenderness, no pain with range of motion (ROM), and “fatigue/pain.”  The VA rated the plantar fasciitis on the right at 20% (unilateral, severe) citing swelling, tenderness, weakness with pain, and use of assistive devices.  The left foot was rated 0% (mild), citing no evidence of painful motion, weakness or abnormal weight bearing.  Both were analogously coded 5299-5276 (flatfoot, acquired) and assigned 2 years from the date of separation (2 April 2010).  

The Board considered the evidence for a higher rating and other bilateral coding avenues to include pathology extending along the entire foot.  Both the right and left feet had similar findings throughout the STR (bilateral tenderness at the heels and arches with normal ROMs).  Member consensus was that the documentation of “normal arches” did not support either foot codes of 5276 or 5278 (flat or claw foot).  Additionally, absence of specific boney involvement in either foot excluded other bilateral codes such as 5279, 5280, or 5283.  There was no prior to separation documentation of weakness in evidence to support code 5277.  Unilateral codes such as 5284 (other foot injuries) were not applicable in this case.  Although the PEB’s choice of utilizing a muscle code in rating a bilateral condition was not strictly in accordance with VASRD guidelines, Board members agreed that any other bilateral coding scheme would not support a level above the PEB’s current 10% rating for each foot and therefore, would confer no additional benefit to the CI.  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 plantar fasciitis condition.  

BOARD FINDINGS: In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.73, the Board unanimously recommends no change in the PEB adjudication.  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 20140401, 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, AR20160006813 (PD201401621)

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