RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00538
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Administrative Specialist, medically separated for plantar fasciitis for the right and left foot, each rated 0%, with a combined disability rating of 0%.  

CI CONTENTION:  Contends plantar fasciitis, migraines and eczema.  The 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 - 20061218	VARD - 20070621	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot Plantar Fasciitis	5399-5310	0%	Left Foot Plantar Fasciitis	5299-5278	0%	20070327	
Right Foot Plantar Fasciitis		0%	Right Foot Plantar Fasciitis		NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Left and Right Plantar Fasciitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot pain began in April 2004. She had flexible pes planus with plantar fasciitis and was treated conservatively with non-steroidal anti-inflammatory drugs and rest.  She began to favor her right foot which also developed pain, with treatment beginning in January 2005.  Radiographic imaging was normal. Surgery was not indicated.  Despite treatment (including foot inserts, physical therapy and injections), the left and right foot conditions could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic symptomatic plantar fasciitis, bilateral” for PEB adjudication.  
The 2 November 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic bilateral foot pain aggravated by walking, prolonged standing and strenuous activity.  The physical examination showed a normal gait.  There was no erythema, discoloration, or edema of the feet.  There was tenderness to the plantar fascia insertion towards the heels and along the plantar medial longitudinal arch bilaterally.  

At the 27 March 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported bilateral foot pain with standing and walking.  Treatment included arch supports.  X-rays of the ankle and feet were normal.  The physical examination showed normal posture and gait.  There was slight bilateral pes planus with foot valgus that corrected with walking.  There was slight tenderness over the plantar surfaces of both feet.  There was no pain on toe dorsiflexion or tenderness on palpation of the metatarsal heads.  There was no hammertoe or pes cavus.  Both ankles had dorsiflexion to 20 degrees (normal) and plantar flexion to 45 degrees (normal) with the right ankle having painful motion on repetition.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left and right foot conditions each at 0%, analogously coded 5399-5310 (Group X – muscle).  The VA rated the left foot condition 0%, and the right foot condition as not service connected, analogously coded  5299-5278 (claw foot [pes cavus]), based on the C&P examination 2 months after separation, citing slight symptoms on the left and no service evidence of a right foot condition.  

There was no evidence that the muscle impairment rose to the level of “moderate” (for the next higher 10% rating) in either foot IAW VASRD §4.55 and §4.56.  Alternative coding under 5278 would also not yield any higher rating.  There was insufficient evidence of pain-limited motion of either ankle (or collection of minor joints) for higher alternative rating under code 5020 (synovitis).  The Board next considered analogous rating under code 5276 (flatfoot, acquired) and deliberated if the CI’s symptoms more nearly approached the 10% criteria of “Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation or the feet, bilateral or unilateral" or the 0% criteria of "mild:  symptoms relieved by built-up shoe or arch support."  

The CI’s bilateral foot symptoms were not relieved by arch support and her duty-limiting symptoms were adjudged as greater than “mild,” warranting a 10% rating analogous to code 5276.  This 10% rating is a single rating for the bilateral condition IAW VASRD code 5276.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left and right plantar fasciitis conditions, coded 5020-5276.  

BOARD FINDINGS:  In the matter of the left and right plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 5020-5276 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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	
Bilateral Plantar Fasciitis	5020-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004804, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

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.

Sincerely,

Enclosure