RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00164
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmission Systems Operator-Maintainer, medically separated for “bilateral foot pain secondary to plantar fasciitis,” with a disability rating of 0%.  

CI CONTENTION:  The CI requests the panel consider all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20040830	VARD - 20050527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain Secondary to Plantar Fasciitis	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5276	0%	20050512	
Morton’s Neuroma	Not Unfitting	Status Post Excision Left Foot Morton's Neuroma	5279	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain Secondary to Plantar Fasciitis.  The PEB combined the bilateral foot pain condition as a single unfitting condition analogously coded 5399-5310 (movements of forefoot and toes) 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.  The panel’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 panel 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 DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain began in November 2001 during basic training without trauma.  The CI underwent left foot surgery with Morton’s neuroma excision in October 2003 for chronic foot pain.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic bilateral foot pain and Morton’s neuroma” for PEB adjudication. 

The 13 July 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued to have constant bilateral 7/10 foot pain made worse with prolonged standing, running, carrying a rucksack, and wearing combat boots.  The physical examination showed a well healed scar over the 2nd and 3rd web spaces of the left foot.  There was mild tenderness to palpation over the plantar aspect of both feet.  Range of motion of both feet as measured with a goniometer was 15 degrees (20 normal) of dorsiflexion and 35 degrees (45 normal) of plantar flexion.  There was no swelling and no obvious deformities, and the extremities are neurovascularly intact distally.  Imaging studies of both feet showed only a calcaneal spur of the left foot.  Final diagnosis was chronic bilateral plantar fasciitis left worse that right and Morton’s neuroma that had failed to respond to surgery and steroid injections.  

At the 15 July 2004 Foot Specialist evaluation, 5 months prior to separation, the CI complained of some pain to the left heel, but not as bad as before.  The neuroma of her left foot was not as bad either.  She had been going back to work and did have to shuffle her feet when walking after standing for extended periods.  The physical examination revealed mild pain to palpation of the left plantar heel and no pain to palpation of right heel.  The left second intermetatarsal space revealed mild pain when pressing on the nerve plantarly, no pain on compression.  At the 17 August 2004 Foot Specialist evaluation, 4 months prior to separation, the CI complained of aching pain to both balls of foot and heels when standing a lot but stated that the pain was much better after the surgery, injections, and shockwave treatment.  The physical examination revealed mild pain to palpation of bottom of her left heel; no pain to palpation of right heel.  The left foot second intermetatarsal space revealed mild pain when pressing on the nerve and no pain with foot compression.  

At the 12 May 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported not being able to stand more than 20 minutes.  The physical examination showed the left foot had a 2-inch scar on the dorsal surface between the second and third toes.  There was no swelling of either feet.  She had full range of motion and manipulation of the forefoot and hind foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain 0%, analogously coded 5399-5310 (Group X. Function: Movements of forefoot and toes).  The VA  also rated the bilateral foot pain 0% analogously coded 5299-5276 (Flatfoot, acquired: (pes planus)), based on the VA C&P examination 5 months after separation, citing “mild symptoms relieved by built-up shoe or arch support” and noting the CI had full range of motion and no swelling in either foot.  The panel first considered if each foot, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Only the left foot was profiled and limitations included no running or walking more than 2.5 miles and was allowed to wear soft shoes.  According to the commander’s statement dated 22 June 2004, the CI’s physical impairments prevented her from fulfilling the requirements of her military specialty.  However, at the NARSUM examination both ankles had a moderate range of motion limitation for a rating of 10% (5271).  Panel members agreed that the evidence reasonably justified that the functional limitations of each foot contributed to the CI’s inability to perform her military duties and accordingly separate disability ratings are recommended.  There was no marked ankle limitation of motion to justify a 20% rating (5271).  There was no foot weakness which supported a rating under the diagnostic codes for weak foot (5277).  There was no evidence of claw foot (5278) of acquired flatfoot (5276).  There was evidence of only slight ongoing foot pain that could be analogously coded under 5399-5310 (Group X. Function: Movements of forefoot and toes) rated at 0%.  There was no other VASRD §4.71a route to a higher rating under any applicable code for the feet or ankles.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommended a disability rating of 10% for the left foot pain, coded 5271 (Ankle, limited motion of) and 10% for the right foot pain, coded 5271 (Ankle, limited motion of).  

Contended PEB Condition:  Morton’s Neuroma.  The panel’s main charge is to assess the fairness of the PEB’s determination that Morton’s Neuroma was not unfitting.  The Morton’s Neuroma was not profiled, implicated in the commander’s statement or was not judged to fail retention standards.  There was no performance-based evidence from the record that Morton’s Neuroma significantly interfered with satisfactory duty performance at separation.  The CI’s foot specialist examinations showed that she had steady ongoing improvement of her specific neuroma symptoms.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination Morton’s Neuroma and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left foot pain, the panel unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  In the matter of the right foot pain, the panel unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  In the matter of the contended Morton’s Neuroma condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Foot Pain	5271	10%	
Right Foot Pain	5271	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150217, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005962, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXXX.

Sincerely,	
Enclosure