RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02197
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fire Control Repairer, medically separated for “bilateral plantar fasciitis” and “left ankle pain,” rated 20% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Please 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 progression or complications of service-connected conditions after separation.  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 - 20060603	VARD - 20080122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis 	5399-5310	10%	Plantar Fasciitis With Pes Planus, Left Foot	5284-5276	0%	20070928	
	5399-5310	10%	Plantar Fasciitis With Pes Planus, Right Foot				
Left Ankle Pain 	5099-5003	0%	Degenerative Joint Disease Of Left Ankle	5003	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral plantar fasciitis (PF) condition began in November 2003 after developing the onset of pain in the plantar surfaces of both feet while in basic training.  The CI was diagnosed with bilateral pes planus (flat foot) and PF by podiatry and treated with conservative measures with improvement in her bilateral foot pain but was unable to return to full physical activities, to include running and marching, without return of pain.  In the 12 months before separation, there were no treatment visits in the STR for foot pain.  The 7 February 2006 permanent profile listed chronic PF and “cartilage injury to ankle” and indicated the CI could participate in an alternate event for the Army physical fitness test (APFT).  

The 11 January 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral foot pain with ambulation and prolonged standing.  The NARSUM noted the CI had “pain a minimal part of the day at 3/10 intensity” and with field training the pain increased to 7/10 intensity.  The physical examination findings of the MEB DD Form 2808 showed tenderness of the bottom of both feet.  Podiatry examination findings were cited and showed normal neurological examination of the feet with normal pulses.  

At the 28 September 2007 VA Compensation and Pension (C&P) evaluation, 16 months after separation, the CI reported that her bilateral PF pain was improved since being out of the military and not wearing boots.  She no longer wore orthotics because she no longer had foot pain.  Physical examination of the feet showed mild pes planus.  There was no tenderness of the PF.  There were no callosities or toe deformities.  There was no evidence of abnormal weight bearing.  The Achilles tendons were not tender.  The CI had a normal gait and was able to heel and toe walk without difficulty.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral PF condition 10% for the right PF and 10% for the left PF, coded analogously to 5310 (muscle injuries, group X), an analogous code for PF, citing no response to conservative therapy.  The VA rated PF with pes planus conditions of the right and left foot each 0%, coded 5284-5276 (foot injuries, other analogous to flatfoot, acquired), based on the non-compensable C&P examination 16 months after separation.

The panel noted that the CI was able to complete an alternate APFT event and there were no treatment notes in record for unilateral or bilateral foot pain in the year before separation.  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.  The VA examination performed 28 September 2007 was beyond the panel’s normal 12-month window for consideration of VA evidence for its rating recommendation.  However, the VA examination provided support that the CI had not required additional medical care for the feet since separation, she was on no medications and no longer used shoe inserts.  

The PEB assigned a 10% rating for each foot coded 5399-5310.  However, the panel majority determined that the evidence above supports that the PF conditions were better characterized as “slight” than “moderate” for 0% rating each when coded as 5399-5310.  The panel considered if a higher rating than 0% was supported for either or both feet coded analogously to acquired flat foot (5276), an applicable alternative code IAW VARSD §4.71a (musculoskeletal conditions).  There was evidence of pain with foot manipulation and use (whether unilateral or bilateral) for a 10% rating coded 5299-5276.  There was no evidence of severe pes planus of either foot for higher rating under 5276 (acquired flatfoot).  Panel consensus was that the disability due to the PF conditions could not be characterized as moderate for higher ratings under 5284 (other foot injury).  There was therefore no higher rating available for either foot under any VASRD foot or analogous codes.  The panel may recommend a lower rating for individual PEB conditions, however, the panel may not recommend a lower combined rating than that of the PEB.  Therefore, the panel next reviewed the left ankle condition before concluding its deliberations on the PF conditions.  

Left Ankle Pain.  According to the STR and MEB NARSUM, the CI’s left ankle pain condition began in July 2004 while playing soccer.  The CI reported pain with walking but she was on a profile for the PF which limited activities that exacerbated the left ankle as well.  A bone scan of the feet showed increased uptake in the left ankle and magnetic resonance imaging showed an osteochondral defect of the ankle joint.  

The 11 January 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain in the left ankle every day or every other day for minutes to hours with improper movements.  The physical examination findings of the MEB DD Form 2808 showed mild pain on range of motion (ROM) of the left ankle.  Podiatry examination findings were cited and showed normal neurological examination of the foot with normal pulses.  Left ankle ROM measurements showed a dorsiflexion of 10 degrees (normal 20) and a plantar flexion of 55 degrees (normal 45), with mild to moderate pain with ROM.  

At the 28 September 2007 VA C&P evaluation, performed 16 months after separation, the CI reported pain with walking more than 30 minutes and occasional swelling of the left ankle as well as other joints.  She reported her flat feet caused ankle pain.  She denied flare-ups and was not using a brace.  Physical examination showed a normal gait and tenderness of the left ankle without effusion.  There was full ankle ROM without discomfort. The feet showed mild pes planus.  There was no tenderness of the PF.  There were no callosities or toe deformities.  There was no evidence of abnormal weight bearing.  The Achilles tendons were not tender.  The CI was able to toe and heel walk but reported pain the left calf walking on the heel.  The CI was able to squat but noted stiffness in the left ankle.  Left ankle radiographic (X-rays) showed degenerative arthritis of the joint.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle pain condition 0%, analogously coded 5003 (arthritis, degenerative), citing symmetrical and non-ratable ankle ranges of motion.  The VA rated the left ankle condition 0%, coded 5003 (arthritis, degenerative), citing lack of objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement.

There was evidence of moderate ankle limitation of motion at the MEB NARSUM examination to support a 10% rating coded as 5271 (limitation of ankle motion) as well as painful motion. The VA examination reported imaging evidence of degenerative joint disease with pain with ankle motion evidenced by pain with heel walking to support 10% rating under 5003 or coded as 5299-5271 for painful motion.  There is no higher rating for an individual joint under 5003, and there was no evidence of marked limitation of ankle motion at either the MEB NARSUM or VA examinations for a higher rating.  The panel unanimously agreed that the left ankle condition warranted a 10% rating at separation, coded 5299-5271.  

The panel majority concluded that although its deliberations arrived at a 20% combined rating through a different rating rationale, a combined rating of 20% as adjudicated by the PEB was appropriate in this case and therefore recommendations to change the adjudications of the unfitting conditions provided no combined ratings benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend changes in the PEB adjudication for the bilateral PF and left ankle pain conditions.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition IAW VASRD §4.73, the panel majority recommends no change in the PEB adjudication.  In the matter of the left ankle condition IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.   There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150813, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010610, 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,