RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04299
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Physical Therapist Technician, medically separated for “chronic bilateral foot pain”, with a disability rating of 0%.

CI CONTENTION:  The CI contended he was given a higher rating for his conditions by the VA and was not evaluated for his PTSD condition.  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 - 20051220	VARD - 20061205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5399-5310	0%	Right Plantar Fasciitis …	5284	10%	20060819	
			Left Plantar Fasciitis …	5284	10%		
Obstructive Sleep Apnea	Not Unfitting	Obstructive Sleep Apnea	6847	50%	20060824	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 90%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic bilateral plantar fasciitis condition began in in 2002.  Although he initially had improvement with inserts, medications, and shoes of comfort, his symptoms persisted and he was no longer able to meet duty requirements.  The MEB forwarded intractable plantar fasciitis for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 27 May 2005, 10 months prior to separation, the CI reported ongoing plantar fasciitis and heel spurs.  The examination of his feet was checked as normal.  The MEB NARSUM examination was dated 10 June 2005, 10 months prior to separation, noted that the CI had persistent pain despite treatment.  X-rays showed bilateral heel spurs, a bony reaction common in plantar fasciitis.  At the VA Compensation and Pension (C&P) evaluations performed on 19 and 24 August 2006, 5 months after separation, the CI reported that his foot pain was aggravated by prolonged standing and walking, but denied limitations in either.  His gait was normal on both examinations and the examination of the feet was normal on the general examination.  Tenderness was documented on the examination specific for the feet.  The motor examination was also normal as were X-rays of the ankles.  The ROM was noted to be full and pain free.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB initially determined the CI fit for duty, but on appeal, rated the bilateral foot pain condition at 0%, coded 5399-5310 (analogous to Group X muscle dysfunction) for slight dysfunction.  The VA rated left and right plantar fasciitis with calcaneal spur at 10% each, coded 5284 (other foot injuries), at the moderate level, based on the VA C&P examinations 5 months after separation, citing pain with palpation.  The Board noted that the CI denied limitations in standing or walking and was observed to have a normal gait on both VA examinations.  This is more consistent with a slight rather than a moderate impairment.  The Board considered the rating options.  The code 5310 used by the PEB does not address a bilateral condition and the Board members opined that the code should have been used for each foot rather than both.  It does address the plantar aponeurosis though.  A slight disability, which is in evidence here, supports a 0% rating for each foot.  This provided no rating advantage to the CI.  The Board also considered the 5284 code used by the VA, but noted that the impairment documented on the VA C&P examinations, which are most proximate to separation, is no more than slight.  This also supported a 0% rating for each foot.  The Board then considered the code 5024 (tenosynovitis).  This code uses the 5003 code (degenerative arthritis) rating criteria.  These are based on limitation in motion which was not present on the VA C&P examinations.  Again, no route to a rating higher than the 0% rating adjudicated by the PEB was found.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral plantar fasciitis condition.  

Obstructive Sleep Apnea (OSA).  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled and judged to fail retention standards.  However, he was under treatment for almost 3 years at the time of separation.  During this period, his performance report recommended immediate promotion.  The commander’s statement noted that his performance was excellent and only cited his feet as limiting duty.  While the CI reported symptoms, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, 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 plantar fasciitis condition and IAW VASRD §4.71a and §4.73, the Board majority recommends no change in the PEB adjudication.  In the matter of the contended obstructive sleep apnea condition, the Board unanimously recommends no change from the PEB determination 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 20141111, w/atchs
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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018374 (PD201404299)

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