RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00742
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Medical Specialist, medically separated for “chronic bilateral plantar fasciitis [PF],” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 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 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 - 20031209	VARD – 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral PF	5399- 5310	0%	No VA Claim Filed	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --	

ANALYSIS SUMMARY:  

Bilateral PF.  The PEB combined the right and left PF conditions as a single unfitting condition coded analogously to 5310 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 Board’s initial charge in this case was 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 Board 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 Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral PF conditions is presented below, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  
According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in June 2003.  The CI was treated for chronic bilateral foot pain, including evaluation by an orthopedic specialist.  Bilateral foot X-rays were normal.  Bone scan noted focal uptake in the left calcaneus (heel bone), but no abnormality of the right foot.  The MEB forwarded “chronic bilateral plantar fasciitis” for PEB adjudication.  The permanent prolife listed chronic PF.  The commander’s statement implicated chronic bilateral PF as impairing the CI’s successful performance of the duties of his MOS and inability to participate in training requiring lifting or running.  The MEB NARSUM examiner determined the CI fell below retention standards due to bilateral PF.  The MEB NARSUM examination on 5 November 2003, 2 months prior to separation, noted complaints of constant bilateral foot pain unrelieved by inserts and requiring daily use of narcotic pain medication.  Physical examination showed pes cavus (high arch) of moderate severity bilaterally.  There was tenderness of the bottom of both feet, without redness or swelling.  No VA Compensation and Pension (C&P) evaluation was in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, analogously coded 5310 (Muscle group X), citing pain that was constant and slight.  There was no VA Rating decision in record.  The Board first considered if both the right and left PF conditions remained separately unfitting when considered apart from the PEB’s combined adjudication.  Both feet were permanently profiled, implicated by the commander’s statement and judged to fail retention standards by the MEB NARSUM examiner.  The Board concluded there was not a preponderance of evidence of the service records that overcame the Board’s presumption that the bundled right and left PF conditions were each reasonably considered separately unfitting.  The limited clinical evidence in record was identical for both feet; therefore, the Board then considered its rating recommendation for the right and left foot conditions together at the time of separation.  

The Board reviewed the rating criteria of 5310 IAW VASRD §4.73 (muscle injuries) which are subjective, with a 0% rating for “slight”, 10% rating for “moderate”, 20% for “moderately severe,” and 30% for “severe” muscle injury.  The Board considered when rating the disability due to PF analogously coded 5399-5310, the discrimination between the “slight” and “moderate” characterizations depends on the presence of at least one “cardinal sign or symptom” of muscle injury specified as “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement” for “moderate”, as opposed to none for “slight”.  At the MEB examination the CI reported constant bilateral foot pain aggravated by weight bearing activities and the exam noted pes cavus with TTP of the bottom of both feet.  The Board concluded based on the presence of pain with use and tenderness with manipulation of each foot, the disability due to both foot conditions were best described as “moderate” and not “slight” and each foot met the 10% rating.  The Board judged the condition could not be characterized as “moderately severe” for either foot.  Alternatively coding the foot conditions IAW VASRD §4.71a analogous to 5020 (synovitis), an analogous code for PF, the Board found 10% rating for each foot was also supported, but no higher, for functional loss due to pain on use (based on §4.59, §4.40 and §4.45).  Finally, coding as 5278 (acquired claw foot) resulted in no higher than a 10% rating combined for both feet for bilateral pes cavus.  There was no evidence of pes cavus with all toes hammertoes, limitation of ankle dorsiflexion of 0 degrees (normal 20) and marked tenderness under the metatarsal heads for a higher rating for either foot or both feet.  There was no higher rating than 10% for each foot with any applicable VASRD code for either foot.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of unfitting right PF and unfitting left PF conditions, each rated 10%, both coded 5399-5310.

BOARD FINDINGS:  In the matter of the chronic bilateral plantar fasciitis condition, the Board unanimously recommends a disability rating as follows: an unfitting right PF condition and an unfitting left PF condition, each rated 10%, both coded 5399-5310 IAW VASRD §4.73.  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	
Chronic Right Plantar Fasciitis	5399- 5310	10%	
Chronic Left Plantar Fasciitis	5399-5310	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011931, 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