RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02138
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Motor Transport Operator) medically separated for chronic left foot pain status post plantar fasciotomy.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his profile allowed for all alternate aerobic events to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition characterized as “chronic left foot pain secondary to plantar fasciitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic left foot pain as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions.”

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:  

IPEB - Dated 20050708	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot Pain…	5399-5310	0%	Plantar Fasciitis, Left Foot	5299-5284	10%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other  5 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060316 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Left Foot Pain Condition.  The narrative summary noted the CI developed pain on the bottom of his left foot causing him to be unable to run.  Notes in the STR indicated a heel spur (by X-rays), but the CI’s pain was not decreased by taping for the heel spur.  Bone scan showed increased uptake at the origin of the plantar fascia and the CI was diagnosed with plantar fasciitis (PF).  He was treated with medications, orthotics, exercise, casting, and injections without relief.  The CI was evaluated by orthopedics and underwent plantar fascia release surgery 23 September 2004.  Despite surgery, the left foot remained painful and an MEB was initiated.  At the MEB exam on 6 June 2005, the CI reported left foot pain, aggravated by running or walking on uneven ground.  The MEB physical exam noted foot dorsiflexion of 15 degrees (normal 20) and plantar flexion of 40 degrees (normal 45) and left foot ROM was equal to the right foot.  There was an area of firmness deep to the surgical incision that was very tender to palpation.  Strength, sensation, and reflexes of the foot were normal.  

The CI did not attend a scheduled VA Compensation and Pension (C&P) exam on 15 December 2005.  At a VA C&P exam on 28 November 2006, 22 months after separation, the CI reported left foot pain aggravated by weight bearing activities.  He reported some relief with medications and orthotics and no job restrictions or flare-ups.  The exam noted a limp, without use of a cane or a crutch.  No pain with manipulation of the foot was noted, but the surgical scar was “exquisitely” tender.  Foot X-ray noted the heel spur, without other abnormality.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 0%, coded 5399-5310 IAW §4.73 (muscle injuries), an analogous code for PF, for “slight” muscle injury.  The VA rated it 10% coded as 5299-5284 (other foot injury) for “moderate” other foot injury IAW §4.71a (musculoskeletal conditions).  The Board reviewed the rating criteria of 5399-5310 which are subjective, with a 0% rating for “slight,” 10% rating for “moderate,” 20% for “moderately severe, and 30% for “severe” muscle injury.  The Board considered that when coding the disability due to PF analogously as 5310, the discrimination between the “slight” and “moderate” characterizations depends on the presence of at least one “cardinal sign or symptom” of muscle injury specified as loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement” for “moderate,” as opposed to none for “slight.”  In the STR and at the MEB examination the CI reported constant foot pain aggravated by weight bearing activities.  Therefore, the Board concluded that based on the presence of the cardinal symptom of fatigue-pain, the disability due to the left foot was best described as “moderate” and not “slight” and met the 10% rating, but judged it could not be characterized as “moderately severe,” which by analogy Members judged would require more symptoms and greater objective evidence of foot abnormalities such as swelling or pain on manipulation of the foot.  Likewise, a 10% rating could be achieved with 5284 (other foot injury) for “moderate” foot injury, but by similar reasoning as noted for the 5310 criteria the Board did not find the evidence supported a “moderately severe” foot injury, and there was no evidence of flatfoot or claw foot deformity or malunion/non-union of tarsal/metatarsal bones to support a higher rating.  The Board also agrees that the evidence does not show additional functional limitations which approximate the criteria for a higher rating under any applicable codes with consideration of VASRD §4.40 (Functional loss) and §4.45 (The joints).  Thus, the Board concluded the left foot could be rated 10% and no higher.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left foot condition coded 5399-5310.  

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 condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5310 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 follow effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Left Foot Pain 	5399-5310	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140508, 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, AR20160004490 (PD201402138)

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 10% 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