RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03202
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20070524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI)  was an active duty E3, Motor Transport Operator, medically separated for “bilateral plantar fasciitis” with a disability rating of 10%.

CI CONTENTION:  The CI states that his conditions continue to worsen and he requests consideration of 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 upon a 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 - 20070504	VARD - 20070717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5276	0%	STR	
Palatal Defect… Nasopharyngeal Mass	Not Adjudicated
Not Unfitting	Cleft Palate Surgery	6820	0%	STR	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Foot Condition.  The PEB combined the right and left foot conditions as a single unfitting condition coded analogously to 5310 and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the Disability Evaluation System (DES) or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left foot conditions are presented together, with attendant recommendations regarding separate unfitness and rating in the rating discussion.

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the bilateral foot symptoms began during basic training in 2005.  The enlistment physical documented mild, asymptomatic, pes planus (flatfoot).  Bilateral foot weight bearing X-rays showed bilateral pes planus deformities.  The 11 September 2006 physical examination by podiatry documented a normal gait.  The bilateral foot examination revealed calcaneal eversion, pes planus, and medial plantar arch tenderness.  There was no swelling, warmth, erythema (redness), or induration (loss of elasticity and pliability).  The skin was normal with no fissures, calluses, abrasions, or skin breakdown.  Strength, sensation, and pulses were normal.  The diagnoses listed chronic, unremitting plantar fasciitis and symptomatic flat foot.  The podiatrist documented that the CI declined surgical options.  Bilateral foot X-rays showed moderate pes planus.  Despite treatment, the bilateral foot condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic bilateral plantar fasciitis” for PEB adjudication.

The MEB examination (DD Form 2808) in February 2007 documented severe, symptomatic, pes planus.  During the 29 March 2007 MEB NARSUM, 2 months before separation, the CI complained of chronic bilateral foot pain.  The physical examination was very limited which revealed bilateral moderate pes planus defects upon weight bearing and pronounced plantar fascia tenderness, but was otherwise unremarkable.

At the VA Compensation and Pension (C&P) examination, 6 months after separation, the CI complained of daily pain at the mid-arches and balls of his feet.  Pain was exacerbated by prolonged standing (> 2 hours), walking (> 1 mile), and running and relieved with medication (Advil).  He denied use of any corrective devices, shoes, inserts, or braces.  The physical examination documented a normal gait, no assistive device, and abnormal lateral heel wear on the shoes.  Bilateral foot revealed valgus deformities (big toe joint pushing outward) with weight-bearing, pes planus, and plantar tenderness (heels and metatarsal heads).  There was no pronation, edema (excess tissue fluid swelling), bunions, or hammertoes.  The skin was dry with some breakdown along the heels with no calluses.  There was no pain on passive or active manipulation of the foot.  Strength and deep tendon reflexes were normal.  The diagnosis listed bilateral plantar fasciitis with residual chronic pain.

The Board directed attention to its rating recommendation based on the above evidence.  As previously elaborated, the Board must first consider whether each foot condition remains separately unfitting, having been de-coupled from a combined PEB adjudication.  Throughout the STR, the bilateral foot complaints were treated equally and concurrently.  Little distinction was documented between the bilateral feet by the CI or examiners.  The PEB assigned a 0% rating, coded analogously 5310 (muscle group X intrinsic muscles of the foot) citing mild asymptomatic pes planus by entrance physical and bilateral plantar fasciitis developed in basic training.  The VA assigned a 0% rating, analogously coded 5276 (flatfoot, acquired) based on the VA C&P examination 6 months after separation, citing bilateral plantar fasciitis, pes planus, and metatarsalgia, valgus deformity, and flat feet with weightbearing, heels and metatarsal heads tenderness, and no corrective devices, shoes, inserts, braces, edema, or callosities.  The proximate examinations documented that gait, strength, reflexes, and sensation were normal.  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).  The Board agreed that foot symptoms more closely approximated the moderate (10%) than the slight/mild (0%) rating under 5310 (muscle group X, foot muscles) and 5275 (flatfoot, acquired) codes.  The Board considered the option of rating both feet together, noting that the PEB and VA rated the feet as a bilateral condition.  The Board majority concluded that the evidence did not provide sufficient grounds for recommending separate foot disability ratings in this case, and that a bilateral rating of 10%, coded 5310 is a good analogy to both the pathology and disability.  Board members agreed that there was sufficient evidence of pain with use, as well objective examination and imaging findings, to support a 10% rating considering VASRD §4.40 (functional loss) and §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 10% for the bilateral foot condition.

Contended PEB Condition:  Palatal Defect, status post removal of Nasopharyngeal Mass Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was reviewed and considered by the Board and there was no performance based evidence from the record the palatal defect, status post removal of nasopharyngeal mass 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 so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the bilateral foot condition, the Board, by a majority vote, recommends a disability rating of 10%, coded 5310 IAW VASRD §4.71a.  In the matter of the contended the palatal defect, status post removal of nasopharyngeal mass condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  The single voter for dissent recommended a disability rating of 20% and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.
The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Bilateral Plantar Fasciitis	5399-5310	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140619 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), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX AR20160011313  (PD201403202)

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 
( ) OVA