RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02993
BRANCH OF SERVICE:  Army	                        SEPARATION DATE:  20091027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Petroleum Laboratory Specialist, medically separated for “bilateral plantar fasciitis,” with a disability rating of 20%.  

CI CONTENTION:  “Please consider all conditions.”  The CI’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 based on 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 – 20090728	VARD - 20100330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5299-5284	20%	Left Foot Plantar Fasciitis	5020	10%	STR	
			Right Foot Plantar Fasciitis	5020	10%	STR	
Bilateral Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%	STR	
Costochondritis	Not Unfitting	Costochondritis	5399-5321	NSC	STR	
Left Shoulder Pain	Not Unfitting	Disability of Left Shoulder	5010	NSC	STR	
Bilateral Knee Pain	Not Unfitting	Disability of Left Knee	5010	NSC	STR	
		Disability of Right Knee	5010	NSC	STR	
Dyspepsia	Not Unfitting	Gastric Ulcer Disease with Dyspepsia	7399-7346	NSC	STR	
Anemia	Not Unfitting	Anemia	7700	NSC	STR	
Adjustment D/O w/Anxiety	Not Compensable	Depression and Adjustment D/O with Disturbance of Emotions	9434-9400	SC for tx only	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the bilateral foot pain began 4 years prior to referral for an MEB.  The Military Entrance Processing Station physical documented asymptomatic moderated pes planus (flatfeet).     Bilateral foot weight bearing diagnostic imaging (X-rays) showed pes planus without associated degenerative changes.  Bilateral foot diagnostic imaging (MRI) studies showed pes planus and normal plantar fascia and tibialis posterior tendons.  At a 3 February 2009 podiatry follow-up the CI complained of continued bilateral foot pain.  He reported wearing inserts and stretching daily.  The MRIs were documented as normal with no pathology of the peroneal tendon, posterior tibial tendon, anterior tibial tendon, extensors, flexors, or bony structures.  The examiner reported “He does have a flat foot but it is flexible and with inserts the subtalar joint is in a more corrected position.”  The podiatrist documented “Patient is advised that there is nothing else that we can do for him in Podiatry.  He has all the modalities to help with his plantar fasciitis bilaterally.  He is considered fit for duty with the clinical exam, however if patient cannot do his Job then do a MEB.”  In the 10 March 2009 NARSUM, 8 months before separation, the CI complained of chronic bilateral foot pain.  Pain was exacerbated by prolonged standing, prolonged walking, and running.  Nonsurgical management, which included activity modification, non-steroidal anti-inflammatory drugs, oral steroids, plantar fascia steroid injections, custom orthotic insoles, and plantar fascia orthotripsy with extracorporeal shockwave therapy (ECSWT), did not result in significant relief of his symptoms.  The author cited the pertinent finding from the DD 2808.  The physical exam documented a normal gait.  The bilateral lower extremity exam revealed severe pes planus with tenderness at the medial insteps.  There was no edema (excess tissue fluid swelling), erythema (redness), skin discoloration, or tenderness over the Achilles tendons.  There was full active range of motion (ROM) of the ankles and all toes.  Strength, sensation, deep tendon reflexes (DTRs), and pulses were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% (right 10% + left 10% + bilateral factor) rating under an analogous 5284 code (foot injuries, other) citing bilateral plantar fasciitis, bilateral tenderness to palpation at medial instep, bilateral foot pain persists despite multiple treatment modalities, and bilateral factor applies.  The VA assigned a 10% rating for the right, and a 10% rating for the left, under the 5020 code (synovitis [plantar fasciitis analogizes to 5020 per analogous codes]) based on STRs, citing bilateral plantar fasciitis, bilateral tenderness to palpation at medial instep, asymptomatic bilateral pes planus at time of enlistment, MRI findings of bilateral pes planus, foot pain began after enlistment, and painful or limited motion of a major joint or group of minor joints.  There was no weakness for consideration under 5277 (weak foot).  There was no evidence of sensory pathology for consideration under 5279 (metatarsalgia).  There was no deformity for consideration under 5278 (claw foot), 5280 (hallux valgus), 5281 (hallux rigidus), 5282 (hammer toe), or 5283 (metatarsal bones malunion/nonunion of).  There is no specific diagnostic code for plantar fasciitis (analogizes to 5020).  The code (5284) used by the PEB characterizes and rates impairment as moderate (10%), moderately severe (20%), and severe (30%).  The code (5020) used by the VARD rates limitation of motion of affected parts as degenerative arthritis (5003) with X-ray evidence (10%) and with X-ray evidence with occasional incapacitating exacerbations (20%).  There was no evidence of incapacitating exacerbations for consideration under 5003.  Board members agreed that the symptoms more closely approximated the 10% than the 20% level of impairment.  The Board concluded the overall disability picture supported a separate 10% rating for each foot.  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 foot condition.

Contended PEB Conditions.  In accordance with DoDI 1332.38, E4.13.1.4 and E5, adjustment disorder with anxiety is a condition or circumstance that does not constitute a physical disability, and is therefore not compensable.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral pes planus, costochondritis, left shoulder pain, bilateral knee pain, dyspepsia (heartburn), and anemia conditions were 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 contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions 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 any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral pes planus, costochondritis, left shoulder pain, bilateral knee pain, dyspepsia, and anemia conditions, the Board unanimously recommends no change from the PEB determinations 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 20140514, 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 AR20160013890  (PD201402993)

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