RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00966
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081203

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

CI CONTENTION:  Bilateral foot condition has continued to worsen and now has knee and spine pain as well as depression.  The right shoulder was injured while in service.  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 - 20081002	VARD - 20090901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis, Bilateral	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5277	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Plantar Fasciitis, Bilateral.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in June 2007 with running.  Diagnostic imaging (X-ray and bone scan) showed bilateral pes planus and uptake at the plantar fascia insertions consistent with plantar fasciitis.  There was no surgical indication and despite conservative treatment with injections, shoe inserts (orthotic devices), ankle braces, and physical therapy the CI continued to have duty limiting bilateral heel pain.  The MEB forwarded “plantar fasciitis, bilateral feet” for PEB adjudication.  Podiatry evaluations throughout 2008 documented a normal gait with bilateral heel tenderness to palpation and a positive plantar fasciitis test.  The Podiatry evaluation in June 2008 noted that each foot had pain elicited by motion.
At the MEB examination (recorded on DD Forms 2807 and 2808) dated August 2008, 4 months prior to separation, the CI reported bilateral plantar fasciitis with ongoing foot pain and use of orthotics.  Physical examination showed “bilateral foot pain” with mild, asymptomatic pes planus.  The MEB NARSUM examination on 5 September 2008, 3 months prior to separation, noted complaints of bilateral heel pain.  X-rays of the bilateral feet were normal.  Physical examination showed bilateral lower extremities with normal reflexes, neurovascular status, and skin examination.  Ankle range of motion was dorsiflexion to 30 degrees (normal 20) and plantar flexion to 40 degrees (normal 45) with no pain elicited on motion.  Examination of the subtalar joints (mid- and hind-foot) elicited no limitation of motion and no pain on motion.  The examiner stated “pain is noted as frequent and moderate.”  There was no VA Compensation and Pension (C&P) examination proximate to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition 0%, analogously coded 5399-5310 (Group X muscle function), citing slight injury for each side.  The VA also rated the bilateral plantar fasciitis condition 0%, coded 5299-5277 (weak foot, bilateral), based on the STRs, citing the missed VA examination and the absence of bilateral weak feet.  The preponderance of STR entries proximate to separation documented tenderness of each heel and foot with objective evidence of pes planus and plantar fasciitis bilaterally.  The last podiatry evaluation clearly indicated pain with motion of each foot.  The MEB NARSUM examination indicated no tenderness or pain with motion, but indicated pain was frequent and moderate.  The Board adjudged that the MEB NARSUM examination was an outlier and that the CI had pain on manipulation of the feet with symptoms not relieved by shoe supports, and that the disability best approximated the 10% (bilateral rating) analogous to 5276 (flatfoot, acquired) and coded 5310-5276.  There was insufficient evidence that either foot condition rose to the moderate muscle injury level IAW VASRD §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities) for any higher rating.  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 bilateral plantar fasciitis condition, coded 5310-5276.

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 5310-5276 IAW VASRD §4.71a and §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	
Plantar Fasciitis, Bilateral	5310-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005300, 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.

Sincerely,	
Enclosure