RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00960
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for bilateral plantar fasciitis, 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 - 20071002	VARD - 20080115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399- 5310	0%	Bilateral Plantar Fasciitis	5276	0%	20071102	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI began having pain in the plantar surface of his feet bilaterally, from the heel to the ball of the foot after returning from deployment in August 2006.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred to an MEB. The MEB forwarded “bilateral plantar fasciitis, bilateral heel pain” for PEB adjudication.  The MEB NARSUM examination on 26 February 2007, 9 months prior to separation, noted complaints of an inability to run without foot pain and difficulty with prolonged standing.  Physical examination showed tenderness of each heel and arch.  The arches were otherwise normal.  According to the commander’s statement on 9 March 2007, the CI’s foot condition precluded him from lifting heavy loads or standing and working for prolonged periods of time.
A podiatry NARSUM addendum examination on 18 July 2007 (4 months prior to separation) noted tenderness of the medial plantar aspect of each heel.  A mild pes cavus (high arch) deformity was noted bilaterally.  Dorsiflexion of each ankle was 10 degrees (normal 20 degrees) and plantar flexion was 50 degrees (normal 45 degrees).

At the 2 November 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported continuous pain in the feet that was worse with extended walking or standing.  He was unable to run.  Physical examination showed a non-antalgic gait, with full weight bearing and normal heel and toe walking.  The feet showed no evidence of callosities or skin breakdown, and there was no unusual shoe wear pattern.  Plantar heel tenderness was present bilaterally.  There was no deformity and the arches were considered to be normal.  Ankle dorsiflexion was 10 degrees and plantar flexion 50 degrees bilaterally.  The CI informed a VA examiner in 2010 that he began work at a superstore in January 2008 (approximately 2 months after separation) stocking shelves and unloading trucks.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, analogously coded to 5310 (Group X. Function: movements of forefoot and toes).  The VA also rated the condition 0% but used the 5276 code (flatfoot, acquired).  The Board considered the PEB’s analogous coding under 5310, which is commonly used for rating plantar fasciitis.  Although the code may be appropriate to plantar fasciitis, a bilateral rating is not compliant with VASRD §4.55 (principles of combined ratings for muscle injuries) which stipulates that each muscle group must be rated separately.  Under 5310, a “slight” severity warrants a 0% rating while “moderate” stipulates 10%.  Board members agreed that “slight” most accurately described the severity of each foot, thus a 0% rating for each foot was warranted.  Since the podiatry addendum noted the presence of mild pes cavus, a rating was also considered under the 5278 code.  A bilateral 10% rating is warranted if the great toe is dorsiflexed, there is some limitation of ankle dorsiflexion and definite tenderness under the metatarsal heads is present.  Although some limitation of ankle dorsiflexion was evident, the other two stipulations were absent; therefore a higher rating was not warranted via this pathway.  The 5284 (foot injuries, other) coding pathway offered no rating advantage over the 5310 code, and the 5276 and 5279 (metatarsalgia, anterior) codes were not clinically applicable.  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 plantar fasciitis condition.

BOARD FINDINGS:  In the matter of the plantar fasciitis condition, the Board unanimously recommends no change in the PEB adjudication.  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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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 been provided to the counsel you listed on your application, Ms. Shelley Wilkinson, 2025 South Washington Avenue, Lansing, MI 48910-0828.

Sincerely,