RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-02301
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060210

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Biomedical Electronics Technician, medically separated for “non-union right 5th metatarsal” and “bilateral plantar fasciitis,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION: “Review all conditions.” 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 – 20060113		VARD - 20060725	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Non-union Right 5th Metatarsal	5283	10%		Status Post Fracture Right 5th Metatarsal	5284	10%	20060614	
Bilateral Plantar Fasciitis	5399-5310	0%		Bilateral Plantar Fasciitis	5299-5020	0%		
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Non-union Right 5th Metatarsal. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right metatarsal condition began in December 2003 following an injury. Surgery was not recommended and further treatment did not result in improvement sufficient to allow unrestricted duty. The 22 December 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of difficulty with prolonged walking and standing. Physical examination showed tenderness along the arch of the feet, as well as across the ball of the feet on the soles bilaterally. The right was significantly more tender than the left. The proximal aspect of the fifth right metatarsal was tender as well, which

reproduces the soldier's pain. Pulses were full and equal bilaterally. The CI had a normal gait. X- ray was consistent with nonunion fracture of the fifth metatarsal. Both feet did show some slight tenderness on the plantar (bottom) surface. At the 14 June 2006 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported 6/10 pain with walking or standing greater than 30 minutes. Physical examination showed both feet had no tenderness, weakness, edema, atrophy or disturbed circulation. He did not have any limitation with standing and walking.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right metatarsal condition 10%, coded 5283 (malunion or non-union of tarsal or metatarsal bones), citing moderate non-union. The VA also rated the right metatarsal condition 10% coded 5284 (other foot injuries), based on the C&P examination 4 months after separation, citing moderate symptoms. There was no foot weakness which supported a rating under the diagnostic codes for weak foot (5277). There was no evidence of claw foot (5278) of acquired flatfoot (5276). The panel agreed that there was evidence of moderate nonunion of the 5th tarsal bone that could be coded under 5283 (Tarsal, or metatarsal bones, malunion of, or nonunion of) rated at 10%. There was no other VASRD §4.71a route to a higher rating under any applicable code for the foot.  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 non-union right 5th metatarsal condition.

Bilateral Plantar Fasciitis. According to STRs and the MEB NARSUM, the CI’s plantar fasciitis condition began in January 1999 after experiencing pain in his feet. The 22 December 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of difficulty with prolonged walking and standing. Physical examination showed tenderness along the arch of the feet, as well as across the ball of the feet on the soles bilaterally. The right was significantly more tender than the left. The proximal aspect of the 5th right metatarsal was tender as well, which reproduces the soldier's pain. Pulses were full and equal bilaterally. The CI had a normal gait. X- ray was consistent with nonunion fracture of the fifth metatarsal. Both feet did show some slight tenderness on the plantar (bottom) surface. At the 14 June 2006 C&P evaluation the CI reported 6/10 pain with walking or standing greater than 30 minutes. Physical examination showed both feet had no tenderness, weakness, edema, atrophy or disturbed circulation. He did not have any limitation with standing and walking.

The panel noted that the PEB rated the bilateral plantar fasciitis as a single unfitting condition. Although VASRD §4.71a permits combined ratings for the feet, it allows separate ratings for separately compensable foot pathology under codes 5284 and 5310. If supported under VASRD
§4.71a, separate ratings for the PEB bilateral foot adjudication may be recommended by the panel if members determine that each joint is reasonably justified as separately unfitting. In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement. Members agreed that each foot was separately unfitting and that identical coding and ratings are applicable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral plantar fasciitis condition 0%, coded 5399-5310 (analogous to muscle group X, the foot and leg), citing slight symptoms. The VA also rated the bilateral plantar fasciitis condition 0% coded 5299-5020 (analogous to arthritis due to trauma and substantiated by X-ray findings), based on the C&P examination 4 months after separation, citing the lack of objective evidence of painful or limited motion of a major joint or group of minor joints. The panel considered whether there was evidence in support of a higher than 0% for either combined or separate rating of the bilateral plantar fasciitis condition. The panel determined that the functional limitations of the bilateral plantar fasciitis condition did not rise to the level of moderate for a 0% disability rating under VASRD codes 5284 and 5310 for either foot. 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 bilateral plantar fasciitis condition.

BOARD FINDINGS: In the matter of the non-union right 5th metatarsal condition and IAW VASRD
§4.71a, the panel unanimously recommends no change in the PEB adjudication. In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.73, the panel unanimously 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 that 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 20150715, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012189, 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