RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00003
BRANCH OF SERVICE:  Army  	                              SEPARATION DATE:  20081204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Aircraft Structural Repairer, medically separated for bilateral plantar fasciitis with a disability rating of 20%.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  Also, he was not evaluated for back pain or issues with depression.  The CI’s complete submission, with attachments, 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 after 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 - 20080919	VARD - 20090314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	10%	Plantar Fasciitis with Pes Planus and First Metatarsophalangeal Joint Stress Reactions	5299-5276	20%	2009022420080806	
	5399-5310	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot condition began and resolved in spring 2003 without history of trauma and recurred bilaterally after a 12 mile road march in April 2007.  Orthopedic foot inserts were prescribed in June 2007 (17 months prior to separation).  Radiographic imaging (bone scan) in July 2007 documented “moderate to severe right plantar fasciitis with periosteal [bony] reaction” with stress reactions of the bilateral great toes and right fifth toe.  Bilateral night splints were given in February 2008 (9 months prior to separation).  Steroid injections were given to the right foot in February and March 2008.  At a podiatry visit in March 2008, the CI reported severe bilateral heel pain.  Physical examination showed “bilateral pain [at the] inferior medial [heel] with atrophy of [the] plantar fat pad.”  At a podiatry visit in April 2008, the physical examination showed “pain [at the] bilateral medial band of plantar fascia with ankle equinus [abnormal positioning],” with atrophy of [the] plantar fat pad and tenderness at the heels.  Custom orthotics were made the next day for the bilateral feet.  At two separation podiatric visits in May and July 2008, physical examination showed bilateral pain along the plantar fascia to the heel with pes planus (flat) foot type and no evidence of edema, weakness, neuropathy, or ankle equinus.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral plantar fasciitis” for PEB adjudication.  

The MEB NARSUM examination was performed on 22 August 2008 (3 months prior to separation).  The CI reported pain that was worse in the morning, especially after using the splints; and worse with standing greater than 10 minutes, and walking greater than ¼ mile.  The physical examination showed pes planus of the bilateral feet, tenderness at the heel and plantar fascia, with a normal neurologic examination.  Ankle range of motion showed bilateral dorsiflexion to 15 degrees (normal 20) and plantar flexion to 35 degrees (normal 40) with pain, and no evidence of muscle spasms, atrophy, swelling or scarring.  

At the VA Compensation and Pension (C&P) examination dated 6 August 2008 (4 months prior to separation), the CI reported pain and swelling, aggravated by lifting, prolonged standing, running, walking, and rucking.  The physical examination showed a normal gait, tenderness of the feet, and bilateral plantar fascia, with otherwise normal range of motion, strength, and no evidence of weakness or swelling.  

At the VA Compensation and Pension (C&P) examination dated 24 February 2009 (3 months after separation), the CI reported bilateral foot pain, right greater than the left, constant wear of orthotic inserts, and inability to stand more than 15-20 minutes or walk greater than ¼ mile.  The CI also reported bilateral stiffness, fatigability, and lack of endurance of the heel, arch and anterior foot with weakness on the right; and denied swelling, and weakness on the left.  The physical examination showed a “painful gait,” with all 4 extremities described as “normal.  Radiographs documented “mild bilateral pes planus,” with no evidence of fracture or degenerative changes.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the “bilateral plantar fasciitis” as 10% for the right and 10% for the left, analogously coded as 5399-5310 (Group X) citing “moderate, bilateral” pain, with a total disability rating of 20%.  The VA rated the “plantar fasciitis with pes planus and first metatarsophalangeal joint stress reaction, bilateral feet” at 20%, analogously coded 5299-5276 (flatfoot, acquired), citing marked deformity, pain on manipulation, swelling on use, and characteristic callosities in the absence of objective evidence of extreme tenderness of the plantar surfaces, marked inward displacement, and severe spasm of the Achilles tendon on manipulation.  

The Board considered the evidence for a higher rating and other bilateral coding avenues to include pathology extending along the entire foot.  Both the right and left feet had similar findings throughout the STR: bilateral tenderness at the heels and arches with normal ranges-of motion.  The abnormal positioning of the bilateral feet noted in April 2008 resolved after use of custom orthotics as noted at the podiatry visits in May and July 2008.  By the time of separation, there was no objective evidence of unilateral or bilateral marked deformity, pain on manipulation and use accentuated, swelling on use, or characteristic callosities in support of a higher rating under 5276.  There was no evidence of limitations at the ankle, shortened plantar fascia, or marked tenderness under the metatarsal heads, in support of a higher rating under analogous code 5278.  There was no prior to separation documentation of weakness in evidence to support code 5277 (weak foot, bilateral).  There was no route to a higher rating under codes 5277 or 5279 (metatarsalgia).  There was no evidence of a moderately severe disability of the function and movements of the forefoot and toes, or propulsion thrust in walking in support of a higher rating under code 5310.  Although the PEB’s choice of utilizing a muscle code in rating a bilateral condition was not strictly in accordance with VASRD guidelines, Board members agreed that any other bilateral coding scheme would not support a level above the PEB’s current 10% rating for each foot and therefore, conferring no additional benefit 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 plantar fasciitis condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the psoriasis was 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.  The psoriasis was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.   The condition was reviewed and considered by the Board.   There was no performance based evidence from the record that the psoriasis 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 contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended psoriasis 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 20141218, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018448 (PD201500003)

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