RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX
	CASE:  PD-2015-01683
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060925

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Armor Crewman, medically separated for “bilateral plantar fasciitis,” with a disability rating of 0%.

CI CONTENTION:  CI contends that the ratings for his bilateral pes planus and mental health condition should be changed.  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 - 20060809	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	
5399-5310	
0%	Plantar Fasciitis, R Foot	5299-5284	0%	20061108	
			Plantar Fasciitis, L Foot	5299-5284	0%	20061108	
			Bilateral Pes Planus	5276	10%	20061108	
Anxiety Disorder NOS	Not Unfitting	PTSD	9411	30%	20061116	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY: 

Bilateral Plantar Fasciitis Diagnosis.  The PEB combined the bilateral plantar fasciitis and pes planus (flat feet) as a single unfitting condition (bilateral plantar fasciitis) coded 5399-5310 (analogous to Group X muscles which include the foot structures) 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 or implied adjudication that each condition was separately unfitting.  The panel initial charge in this case was therefore 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 panel 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 panel 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 right and left plantar fasciitis are presented together, with attendant recommendations regarding separate fitness and rating recommendations, if applicable.

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first evaluated for bilateral foot pain in August 2001.  He reported pain with running and was found to have bilateral pes planus (flat feet) for which he was given orthotics (shoe inserts).  This had limited benefit and he was placed on limited duty in January 2002.  This was extended several times and a permanent profile was considered.  He was next seen in September 2002 and diagnosed with plantar fasciitis.  The CI deployed for a year in April 2003.  The next record in evidence is a primary care note dated 6 December 2004 in which the CI reported that he was tolerating duty and unlimited walking with the orthotics.  His profile allowed an alternate cardiovascular event.  On 6 April 2006, the CI was again seen in primary care and reported a gradual progression of his bilateral foot pain over the past 3 years despite treatment.  He was issued a permanent L3 profile and referred for MEB.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 02 May 2006, 5 months prior to separation, the CI reported ongoing bilateral foot pain.  Severe symptomatic pes planus was found on physical examination.  The MEB NARSUM examination on 23 May 2006, 4 months prior to separation, noted longstanding complaints of painful feet.  On examination, the 74 inch CI weighed 260 pounds.  Pronation of his feet was noted when weight bearing.  He was diagnosed with bilateral pes planus.  X-rays on 3 August 2006 showed mild pes planus with no evidence of fracture or subluxation.  Calcaneal enthesopathy (a bone spur) was noted at the insertion of the plantar fascia, but recorded as on the left under findings and right under impression.  The medical officer observed that this was associated with plantar fasciitis.  Podiatry dictated an addendum to the MEB NARSUM on 4 August 2006.  The bone spur was noted on the right.  The CI was diagnosed with bilateral symptomatic plantar fasciitis, refractory to treatment, and mild pes planus.  The MEB forwarded “pes planus, bilateral,” and “symptomatic plantar fasciitis, bilateral” for PEB adjudication.  

At the VA Compensation and Pension (C&P) evaluation performed on 8 November 2006, 6 weeks after separation, the CI reported bilateral painful feet for which he used orthotics.  His gait was normal although pes planus was present.  Tenderness was noted over the right forefoot.  Bilateral right greater than left pes planus was present with tenderness of the midfoot.  Bilateral pes planus and bilateral fasciitis were diagnosed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition at 0%, coded 5399-5310.  The pes planus condition was subsumed under the plantar fasciitis impairment.  The VA rated the bilateral pes planus condition at 10%, coded 5276 (flat feet), citing pain with manipulation.  The VA rated each foot 0%, coded 5299-5284 (analogous to other foot injuries), for plantar fasciitis.  

The panel first considered if the pes planus and plantar fasciitis conditions were severable for rating purposes.  The impairment from both conditions was foot pain limiting activity.  The treatment for both included orthotics, activity modifications, and medications.  The relative contribution from either condition was not recorded by the examiners, although the podiatrist indicated that the plantar fasciitis condition was the more impairing.  The panel determined that assigning separate ratings for the common impairment would violate VASRD §4.14 (avoidance of pyramiding) and could not be supported.  The code 5276 supports a 10% rating for pain on manipulation for one or both feet.  The findings for a higher rating included marked deformity, swelling and callosities.  These were not present.  The code 5284 supports a 10% rating for a moderate level of impairment.  The panel observed that the CI was symptomatic with impact activities and with prolonged walking.  However, he was noted to have a normal gait at the VA examination which is more consistent with a mild impairment and non-compensable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral plantar fasciitis condition, coded 5276.  

Contended Conditions: Anxiety Disorder.  The panel's main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The anxiety disorder was not listed on the final profile, but was noted by the NARSUM psychiatrist to be an S3.  The CI was determined not to meet retention standards as he was not deployable at that time.  However, this was the only functional limitation listed.  In addition, he was noted to have a mild social and occupational (non-military) impairment and to be responding to treatment.  His prognosis was thought to be excellent.  The commander only noted that the CI had physical limitations in duty performance.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation (other than the limitation from deployment).  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis, the panel unanimously recommends a disability rating of 10%, coded 5276 IAW VASRD §4.71a.  In the matter of the contended anxiety disorder, not otherwise specified, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Bilateral Plantar Fasciitis	5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008785, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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,