RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03806
BRANCH OF SERVICE:  Army	                        SEPARATION DATE:  20011015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Combat Engineer, medically separated for “bilateral chronic recalcitrant plantar fasciitis right greater than left,” with a disability rating of 10%.  

CI CONTENTION:  The CI asserts he has posttraumatic stress disorder (PTSD) which is getting worse and interfering with his ability to maintain employment.  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 - 20010924	VARD - 20011218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain Due to Plantar Fasciitis	5399-5310	10%	Plantar Fasciitis, …Right Foot	5299-5284	10%	STR	
			Plantar Fasciitis, …Left Foot	5299-5284	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain Due to Plantar Fasciitis Condition.  The first record in evidence for the bilateral foot pain condition is a primary care note dated 20 January 2000 in which the CI reported a history of pain for many months and treatment for plantar fasciitis.  X-rays showed bilateral bone spurs consistent with plantar fasciitis.  He was referred to podiatry and a trial of conservative therapy was begun which included medications, injections, orthotics, night splints, and duty modification.  Although he improved, his symptoms persisted and precluded full duty.  He had a surgical release of the right and left plantar fascia on 15 December 2000 and 21 May 2001, respectively.  Following rehabilitation, he continued to have right > left pain.  The narrative summary (NARSUM) was dated 6 August 2001, 3 months after the surgery on the left foot and 2 months prior to separation.  The CI reported that his pain had decreased 50% on the left, but was worse than prior to surgery on the right.  An MRI was stated to have shown increased scar tissue on the right.  He was noted to have slight, intermittent pain, and on examination, to have “extreme pain” over the incision site on the inside aspect (medial) of the right foot.  The left side was noted to have improved without specific comment on tenderness.  He was unable to run, walk, or stand in military footgear for prolonged periods of time.  No comment was made on the gait.  There was not a VA Compensation and Pension (C&P) examination proximate to separation.  The final clinical note in the record, dated 4 September 2001, 1 month prior to separation, documented that the CI was back at work, but did not record his activity level  The VA C&P examination remote from separation, dated 17 October 2008, documented that neither foot was tender or showed abnormal weight bearing.  The gait was normal, although pain with walking was reported.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral foot pain condition at 10%, coded 5399-5310 (analogous to group X muscle function; this includes the plantar fascia).  The VA rated right plantar fasciitis at 10% and the left at 0%, both coded 5299-5284 (analogous to foot injuries at the moderate level for the right).  The Board first considered if each foot was separately unfitting.  It noted that both had surgery, both were painful at separation, and both were profiled.  The evidence supports a finding that each was separately unfitting.  The Board then considered the rating.  A moderate level of disability supports a 10% rating under either code.  The right foot was clearly more symptomatic than the left.  However, the Board did not find evidence to support a moderately severe disability for the right foot or a moderate disability for the left.  While separate ratings could be assigned at 10% and 0%, for the right and left foot, respectively, this provides no advantage to the CI.  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.  The Board therefore concluded that this condition could not be recommended for additional disability rating.  

BOARD FINDINGS:  In the matter of the bilateral foot pain due to plantar fasciitis condition and IAW VASRD §4.71a and 4.73, the Board unanimously recommends no change in the PEB adjudication.  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 20140818, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

28 JUL 2016

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 AR20160011595 (PD201403806)

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