RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01712
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Communications Craftsman, medically separated for “chronic [left] forefoot pain associated with plantar fasciitis,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 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 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 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 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 – 20040722	VARD - 20060707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic [Left] Forefoot Pain…Plantar Fasciitis	5399-5310	10%	Residuals Plantar Fasciitis, Status Post Fasciotomy Release with Achilles Extension, Left Foot	5099-5020	10%	20060106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic [Left] Forefoot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in 2000 after injuring his left foot while playing racquetball.  In April 2002, the CI re-injured his foot after dropping a screwdriver on his foot.  The CI had surgery for a Morton's Neuroma excision and nerve decompression and plantar fasciotomy were unsuccessful in controlling his pain.  The MEB forwarded chronic forefoot pain for PEB adjudication.  The MEB NARSUM examination on 25 May 2004, 10 months prior to separation, noted complaints of chronic foot pain.  Physical examination of the left foot showed tenderness over lateral mid foot in the plantar area.  There was a positive Tinel’s sign (indicates nerve irritation).  The foot had full range of motion without pain.  It was neurovascularly intact, with no foot deformity and a well healed surgical scar.  At the 6 January 2006 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported that it was hard to stand more than 20 minutes and was unable to run due to pain and swelling of his left foot.  Physical examination showed a 3 cm tender scar over the medial calcaneus and a 2 cm scar at the base of the third toe.  His left ankle dorsiflexion was 1 degree and plantar flexion was 15 degrees.  He was able to curl and extend his toes.  He could balance on his toes, rock back on his heels, and balance on either leg.  He did walk with an antalgic gait favoring the left leg.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5399-5310 (analogous to Group X muscle function of the foot and leg).  The VA also rated the left foot condition 10% coded 5099-5020 (synovitis), based on the VA C&P examination 8 months after separation, citing painful motion.  There was no ankle ankylosis to support a rating under the diagnostic code (5270).  There was no marked ankle limitation of motion to justify a 20% rating (5271).  There was no foot weakness which supported a rating under the diagnostic code for weak foot (5277).  There was no malunion or nonunion of the tarsal or metatarsal bones to support a rating under the diagnostic code (5283).  There was no foot injury to justify a 20% moderately severe rating under the diagnostic code (5284).  There was no evidence of claw foot (5278) of acquired flatfoot (5276).  There was evidence of ongoing foot pain that could be analogously coded under 5399-5310 (Group X. Function: Movements of forefoot and toes) rated at 10%.  There was no other VASRD §4.71a route to a higher rating under any applicable code for the feet or ankles.  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 forefoot pain condition.  

BOARD FINDINGS:  In the matter of the chronic forefoot pain condition and IAW VASRD §4.71a, the panel unanimously 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 20150630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01712.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings