RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00963
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “bilateral plantar fasciitis with associated pes planus,” with a disability rating of 20%.  

CI CONTENTION:  CI does not agree with 0% rating.  The CI’s 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 - 20090422	VARD – 20091022 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis with associated Pes Planus	5299- 5284	10%	Plantar Fasciitis, Bilateral	5021	0%	20090814	
		10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Plantar Fasciitis, Bilateral.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s feet began to hurt during basic training and AIT [Advanced Infantry Training] with no specific injury, and got progressively worse.  The CI was evaluated and diagnosed with bilateral pes planus (PP) with plantar fasciitis (PF).  He was treated with medications, physical therapy and orthotics.  The CI was deployed and completed the deployment, however, his foot pain increased and became constant during deployment.  There was no surgical indication.  The MEB forwarded “chronic bilateral foot pain due to pes planus and plantar fasciitis” for PEB adjudication.  

The MEB NARSUM examination on dated 25 March 2009, 4 months prior to separation, noted complaints of bilateral foot pain, equal in both feet, aggravated by weight bearing activities. Physical examination showed an antalgic gait, with limp of both feet.  There was tenderness to palpation of both arches and there was mild to moderate PP of both feet.  There were no neurosensory deficits and pulses were normal.  

The 2 March 2009 VA Compensation and Pension (C&P) evaluation, performed 4 months before separation, also served as the MEB Form 2808 examination.  At the examination, the CI reported bilateral foot pain aggravated by prolonged standing and relieved by rest.  He had a normal gait without use of assistive devices.  The physical exam noted no tenderness to palpation of the feet. There was “mild” PP noted bilaterally, confirmed by X-rays.  At the 14 August 2009 VA Compensation and Pension (C&P) evaluation, performed a month after separation, the CI reported bilateral foot pain, aggravated by activity and relieved by rest.  He reported he was able to function at the time of pain with medication.  The physical exam showed a normal gait.  There was abnormal wear of the heels of the shoes, left greater than right and a callous of the right great toe.  Strength, sensation, and reflexes of the lower extremities were normal.  Exam of the feet was reported as “within normal limits” without tenderness noted.  
Bilateral foot X-rays were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left bilateral PF with associated PP conditions each 10%, for a combined 20% rating, analogously coded 5284 (Foot injuries, other), rated as moderate based on tenderness along the plantar fascia.  The VA rated the bilateral foot condition 0% coded 5021 (Myositis), based on the VA C&P examination a month after separation, citing a non-compensable evaluation for “no evidence of painful or limited motion of a major joint or group of minor joints.”  

The PEB provided 10% rating for each foot condition and the Board may not recommend a lower combined rating than the PEB IAW DoDI 6040.44.  The Board therefore reviewed to see if a higher rating was warranted for either foot condition with any applicable VASRD code.  The Board agreed that the threshold for the higher 30% rating under 5284 was not supported for “moderately severe” foot injury of either or both feet, based upon the intermittent presence of tenderness and antalgic gait noted at the three exams cited above.  The CI also indicated he could function with pain with medication at the post-separation C&P exam.  There was no evidence of “severe” pes planus with “marked deformity,” “swelling on use,” or “characteristic callosities” for higher rating than 10% for each foot.  If coding the bilateral PF analogously to muscle injury as 5399-5310 (muscle group X injury) IAW VASRD §4.73 (muscle injuries), the Board agreed that the disability due to each foot condition was best described as “moderate” (10% rating each) and not “moderately severe” (20% rating each), which Members judged would require more symptoms and greater objective evidence of abnormalities analogous to the criteria set forth under VASRD §4.56 (Evaluation of muscle disabilities), in this case for example findings such as permanent foot deformity, noted swelling with use, or a persistent abnormal gait.  There was therefore no path to a higher evaluation for either foot with any applicable VASRD code.  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.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.71a, the Board 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000898 (PD201500963)

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