RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02313
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Patriot System Repairer, medically separated for “chronic right foot pain,” disability rating of 10%.

CI CONTENTION:  The CI contended for his unfitting condition as well as other conditions rated by the VA.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20031105	VARD - 20040210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	5399-5310	10%	Plantar Fasciitis, with Fibromas, Post-Operative, Right Foot	5015-5310	10%	20031218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Foot Pain.  

According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right foot pain condition began in 1998 when he noticed a right foot fibroma.  

The 29 September 2003MEB NARSUM examination, 4 months prior to separation, noted complaints of “disabling” right foot pain which the CI stated precluded him from standing for more than five minutes at a time and running.  
Physical examination showed two firm, fixed, palpable fibromas on the plantar aspect of the right foot that were tender to palpation.  The right greater toe range of motion (ROM) showed moderate restriction to ROM with dorsiflexion of approximately 5 degrees and 25 degrees of plantar flexion.  The left great toe showed approximately 15 degrees of dorsiflexion and 30 degrees of plantar flexion.  Radiographs of the right foot revealed minor bone spurs of the right great toe distal phalanx as well as mild spurring of the dorsal anterior talus.  

At the 18 December 2003 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported recurrent fibromas and foot pain.  Physical examination showed two tender, small, round, moveable, masses over the medial foot; mid arch; and distal at the base of the metatarsals. There was diffuse tenderness over the plantar surface.  The examiner observed an antalgic gait to the right secondary to foot pain.  

The panel first considered whether the two conditions, chronic right foot pain secondary to plantar fasciitis and chronic right foot pain secondary to recurrent plantar fibromas met criteria for unbundling.  The panel noted there was not any objective or subjective evidence cited in the CI’s file of heel pain, inflammation of the plantar fascia ligament or aching pain in the heel of the foot.  Additionally recognized was that the CI did not complain of any burning, stabbing or aching pain in the heel of the foot that is generally felt in the morning with plantar fasciitis.  After careful consideration, the panel determined that the chronic foot pain secondary to plantar fasciitis was appropriately subsumed with the recurrent plantar fibromas and was not separately unfitting.  IAW 4.14 (Avoidance of Pyramiding).

The panel next directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right foot pain condition 10%, coded 5399-5310 (analogous to, foot and leg, Group X. Function), citing functional limitations in maintaining the appropriate level of mobility.  

The VA also rated the chronic right foot condition 10% coded 5015-5310 (Bone new growth benign-foot and leg, Group X. Function) based on the VA C&P examination 1 month before separation, citing recurrent fibromas and plantar fasciitis with evidence of functional loss due to pain which affects the performance of normal working movements of the right foot with normal excursion, strength, speed, coordination and endurance.  

An assignment of 10% and not higher due to evidence of functional loss due to pain is warranted because there is not any evidence of a moderate severity in disability of this condition.  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 condition.  

BOARD FINDINGS:  In the matter of the chronic right foot condition and IAW VASRD §4.71a, the panel unanimously or majority 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150902, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012481, 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,