RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01113
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E4, Food Service Specialist, medically separated for “chronic right foot pain…” with a disability rating of 0%.

CI CONTENTION:  The CI contends for conditions not identified by either the MEB or PEB. The complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 – 20051117	VARD - 20060928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain…	5399- 5310	0%	Heel Spur Syndrome with Plantar Fasciitis, Right Heel	5299-5279	10%	20060630	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot pain began in 2003 without history of specific trauma.  There was no surgical indication.  The CI’s condition was treated conservatively with medication and custom orthotics, both were minimally effective.  His condition did not improve significant enough to allow for continued military service, therefore, he was referred to the MEB.  The MEB forwarded “chronic right plantar fasciitis, nonresponsive to medical treatment” for PEB adjudication.  

The MEB NARSUM examination on 21 October 2005, 2 months prior to separation, noted complaints of chronic right heel pain.  The CI continued to take medication and noted that he was unable to stand for more than 5 minutes without pain.  He also reported increased pain with walking, running and jumping.  He was unable to perform his duties as a cook because he was not able to stand for prolonged periods of time.  Physical examination showed “good plantar flexion”, and normal sensory and muscle strength examinations.  There was tenderness to palpation along the medial aspect of the right heel.

At the 30 June 2006 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported his daily activities were reduced due to heel pain.  He used orthotics with minimal reduction of pain, and he did not use corrective shoes, shoe inserts or braces.  Physical exam showed normal gait and no evidence of weight bearing issues.  There was tenderness with pressures applied and “severe” pain when pressure was applied directly to the area of the insertion of the plantar fascia to the heels.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot pain 0%, analogously coded as 5310 (Group X. Function: Movements of forefoot and toes), citing the condition as “slight.”  The VA rated the right foot pain 10% analogously coded 5279 (metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral), based on the VA C&P examination 7 months after separation, citing painful symptoms associated with anterior metatarsalgia.  The MEB physical examination did not record any right foot symptoms with the exception of tenderness to palpation along the medial aspect of the right heel.  The C&P exam documented pain with applying pressure to the heel, but otherwise normal exam.  Both examinations documented absence of painful motion, weakness or instability.  The panel agreed that the record sufficiently documented pain; however, preponderance of evidence did not support the higher rating of 10% for moderate impairment under codes 5310.  The panel agreed that the condition was not compensable under any other applicable VASRD code.  The panel concluded, the right foot condition did not rise to a level of compensability under §4.40 (functional loss).  Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right foot pain.  

BOARD FINDINGS:  In the matter of the chronic right foot pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150610, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010780, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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.

Sincerely,