RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03063
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for bilateral plantar fasciitis, rated at 20%.  

CI CONTENTION:  The CI requests consideration of all conditions.   Her 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 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:  

 IPEB - Dated 20060824	VA* - (~3 Mos. and 6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	20%	Bilateral Plantar Fasciitis	5099-5276	10%	20070423	
Adjustment Disorder with Anxiety and Depression; 	Not Unfitting	Major Depression (Claimed as Depression/Anxiety and
Adjustment Disorder)	9434	70%	20061229	
Costochrondritis, Chronic; 	Not Unfitting	Osteopenia, Spondylosis and Degenerative Disease of the Thoracic Spine with Costochondritis	5242	10%	20070423	
Thoracic Spine Myalgia, 	Not Unfitting					
Mild Obstructive Lung Disease	Not Unfitting	Asthma	6602	10%	20070423	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  20%	COMBINED RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20071018 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis Condition.   The CI presented on 9 March 2004 with a 6-month history of recurrent left foot pain.  A bone scan demonstrated evidence of stress reaction.  The CI was treated conservatively.   A treatment note dated 26 July 2004 noted a diagnosis of plantar fasciitis.  A physical therapy note dated 24 November 2004 noted persistent left foot pain despite a trial of orthotics, plantar fasciitis stretches, and manual therapy.  Although the CI reported left heel pain, a bone scan performed 10 January 2005 demonstrated right greater than left inflammation at the insertion of the plantar fascia into the calcaneus (heel).  The CI underwent another course of physical therapy and was placed in a boot in March 2005. The CI reported improvement of the left foot pain with use of the boot, but in April 2005 reported the onset of right foot pain.  Upon returning to a soft shoe in June 2005, the CI reported return of the left foot pain.  The CI was referred to physical therapy for bilateral plantar fasciitis.  The CI was placed in a cast from 8 March to 5 April 2006.  Despite conservative management, the CI continued to report bilateral foot pain secondary to plantar fasciitis.  She declined steroid injection and surgical intervention.  The narrative summary (NARSUM) noted that the CI continued to report chronic pain in both feet, left more than right, which limited her daily activities and prevented performance of APFT and of her normal MOS and mission.  The physical examination demonstrated left greater than right foot tenderness to palpation.  At the VA Compensation and Pension (C&P) examination performed 6 months after separation, the CI reported daily bilateral foot (arch, ball and heel) swelling and sharp stabbing pain.  She continued with stretching exercises and anti-inflammatory medication.  The examiner documented normal foot examination bilaterally.  A diagnosis of bilateral plantar fasciitis was noted.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting bilateral plantar fasciitis condition at 20% analogous to 5310 (moderately severe foot muscle [Group X] injury).  The VA rated the condition at 10% analogous to 5276 (moderate bilateral flatfoot).  The Board consider whether the evidence supported a higher than 20% rating.  The Board determined that the evidence did not support a higher rating under 5310 nor 5276.  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.   

The Board’s main charge is to assess the fairness of the PEB’s determination that adjustment disorder with anxiety and depression, costochrondritis, thoracic spine myalgia, and mild obstructive lung disease 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.  Adjustment disorder with anxiety and depression, costochrondritis, thoracic spine myalgia, and mild obstructive lung disease conditions were profiled at level 2 (capable of all basic work commensurate with grade and position).  The conditions were not 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:  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 bilateral plantar fasciitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with anxiety and depression, costochrondritis, thoracic spine myalgia, and mild obstructive lung disease 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 20140627, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160005012 (PD201403063)

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