RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03596
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Fire Support Specialist, medically separated for “plantar fasciitis, bilateral,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI essentially requested the Board 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 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 – 20081007	VARD - 20090304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis, Bilateral
(10% + 10% + bilateral factor)	5399-5310	20%	Left Foot Plantar Fasciitis with Pes Planus and Arthritic Changes	5271-5010	10%	20081106	
			Right Foot Plantar Fasciitis with Pes Planus and Degenerative Changes	5276-5010	10%		
Pes Planus	Not Unfitting					
Chronic Low Back Pain		Mild Lumbar Strain	5237	10%		
Mild Reactive Airway Disease / Obstructive Sleep Apnea		Sleep Apnea	6847	50%		
Moderate Sensory Neural Hearing Loss		Hearing Loss, Left Ear	6100	0%		
Abdominal Pain		Gastritis	7399-7307	0%		
		GERD	7399-7346	NSC		
Adjustment Disorder with Mixed Disturbance of Emotions and Conduct		Adjustment Disorder with Mixed Disturbance of Mood and Conduct	9440	30%		
Asthma		Asthma	6602	10%		
Chronic Bilateral Ankle Pain		Left Ankle Strain with Mild Arthritic Changes	5010	20%		
		Right Ankle Strain with Arthritic Changes	5010	20%		
Chronic Bilateral Knee Pain		No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Plantar Fasciitis, Bilateral.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in August 2006 after aggressive physical training.  The CI was evaluated and treated for bilateral plantar fasciitis.  Bilateral foot radiographic (X-rays) studies on 18 April 2007 showed pes planus and degenerative changes of the foot.  Podiatry was consulted and agreed with the diagnoses.  The CI was treated with therapy, orthotics, medications, and foot injections without resolution of his foot pain.  Orthopedic evaluation on 28 July 2008 agreed with the bilateral pes planus diagnosis and surgical options were discussed, but the CI declined.  The MEB forwarded “bilateral plantar fasciitis with heel spur syndrome” for PEB adjudication.  

At the MEB NARSUM examination on 25 August 2008, 4 months before separation, the CI reported bilateral foot pain.  Physical examination noted a normal gait.  There was tenderness to palpation of the arches and heels bilaterally.  The CI had difficulty with heel and toe walking due to pain.  Ankle range of motion (ROM) was “adequate” with pain on ankle/foot dorsiflexion.  There were no skin changes or calluses.  There was moderate flat foot (pes planus) without malalignment of the foot.  Ankle reflexes were normal.  Physical therapy measured ROM for the MEB on 5 August 2008, after three repetitions, dorsiflexion of 9 degrees (normal 20 degrees) and plantar flexion of 45 degrees (normal 45 degrees), with painful motion was noted.  

At the 6 November 2008 VA Compensation and Pension (C&P) examination, performed 1 month before separation, the CI reported bilateral plantar fasciitis, arthritis, and pes planus.  He reported daily use of anti-inflammatory medication and ice/heat for pain with good response and occasional use of pain medication for severe pain.  Physical examination showed a normal gait and posture.  There was moderate plantar fasciitis of both feet and tenderness to palpation of the foot diffusely.  There was pain of both feet with weight bearing, pain and stiffness with foot inversion and eversion, and no swelling was noted.  There was no hallux valgus or toe deformity noted on either foot.  Ankle ROM was reported for both feet as full ROM with pain and stiffness.  There was no crepitus or evidence of instability of either ankle.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bilateral plantar fasciitis, as an unfitting right plantar fasciitis and an unfitting left plantar fasciitis condition, each rated 10%, both coded 5399-5310, citing moderate muscle injury, with fatigue-pain, a cardinal sign of muscle injury.  The VA also provided 10% rating each for right and left plantar fasciitis conditions.  The VA coded the left foot 5271-5010 (limitation of ankle motion-traumatic arthritis) and coded the right foot 5276-5010 (acquired flat foot-traumatic arthritis) based on the VA C&P examination, 1 month after separation, citing painful motion or limited motion of two or more major joints or groups of minor joints.  

The rating criteria of 5399-5310 IAW VASRD §4.73 (muscle injuries) 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 plantar fasciitis analogously as 5310 IAW VASRD §4.73, the characterizations depend on the presence of one or more “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.”  There was evidence of foot tenderness, pain and stiffness with motion of both feet, and pain with weight bearing to support a 10% rating for each foot.  

The Board judged neither foot could be characterized as “moderately severe” which required greater objective evidence of foot abnormalities such as malalignment, swelling, or callosities.  Coding the foot conditions as 5284 (other foot condition) IAW VASRD §4.71a, a 10% rating is also supported with 5284 for “moderate” foot injury, but by similar reasoning as noted for the 5310 criteria, the Board did not find the evidence that supported characterizing either foot injury as “moderately severe” for higher individual ratings.  Coding the bilateral pes planus condition as (acquired flatfoot) 5276 provided no ratings benefit because it provides a 10% rating for “moderate” pes planus with pain on manipulation of the feet whether unilateral or bilateral and there was no evidence of “severe” pes planus (marked deformity with swelling and characteristic callosities).  There was no claw foot or malunion or nonunion of tarsal or metatarsal bones of either foot for rating under the respective codes (5278, 5283).  There was therefore no higher rating than 10% with any applicable VASRD code for either foot.  The Board agreed with the 10% rating for each foot, coded 5399-5310 as adjudicated by the PEB.  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 right or left plantar fasciitis condition.  

Contended PEB Conditions:  Pes Planus, Chronic Bilateral Knee Pain, Chronic Bilateral Ankle Pain, Chronic Low Back Pain, Mild Reactive Airways Disease (also listed as asthma)/Obstructive Sleep Apnea (OSA), Moderate Sensorineural Hearing Loss (SNHL), Abdominal Pain, and Adjustment Disorder.  None of the contended conditions were implicated in the commander’s statement or judged to fail retention standards.  None of these conditions were listed on the permanent profile dated 30 September 2008, except the SNHL condition, which was given an H2 profile.  The OSA condition, diagnosed on 25 September 2008, was given a P2 profile on 7 October 2008.  A “2” profile designation indicates a condition which requires some physical limitations, but is not in all cases disqualifying for continued military service.  The pes planus condition was discussed above with the plantar fasciitis condition and is subsumed in the §4.73 rating recommendation for the foot conditions.  

There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance prior to the CI’s referral into the MEB process for bilateral plantar fasciitis.  In accordance with DoDI 1332.38, adequate performance to the point of referral into the physical evaluation process supports a finding of fitness for duty, even if the condition may preclude continued military service.  After due deliberation, and 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the plantar fasciitis, bilateral condition and IAW VASRD §4.73 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended pes planus, chronic bilateral knee pain, chronic bilateral ankle pain, chronic low back pain, mild reactive airways disease (also listed as asthma)/obstructive sleep apnea, moderate sensorineural hearing loss, abdominal pain, and adjustment disorder with mixed disturbance of emotions and conduct 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 20140704, w/attachments
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 
AR20160017552 (PD201403596)

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.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA