RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02366
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Human Resources Specialist, medically separated for “plantar fasciitis right foot” with a disability rating of 0%.

CI CONTENTION:  The CI requested a review of all conditions.  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 - 20061218	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis Right Foot…	5399-5310	0%	Plantar Fasciitis, Right Foot With Surgical Scar	5299-5276	0%	20070602	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Plantar Fasciitis Right Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right foot surgery in June 2005 for right plantar fascial release and exploration of Baxters nerve with neurolysis.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right plantar fascitis [sic]” for PEB adjudication.  At a primary care office visit on 14 April 2005, the CI complained of painful right plantar fasciitis for approximately 18 months duration. The CI admitted to 3 injections to the area that resulted in atrophy (loss of fascia tissue).  After various treatment modalities, such as custom orthotics, physical therapy, heel cushions, ultrasound, injections and other medicinal therapy, her pain level remained significant at 8/10.  At an office visit on 25 July 2005, 2 months after surgery for release of the plantar fascia and exploration of the Baxter nerve right heel, the CI remained with signs of significant atrophy from cortisone injections to the area.  The CI stated that she was not comfortable with ambulation and wearing shoes.  A physical therapy examination report dated 27 July 2005 cited the right foot was very tender to palpation at the medial plantar heel, active range of motion (ROM) 70 degrees at the first metatarsal-phalanx in dorsiflexion and 10 degrees at the right ankle in dorsiflexion.  The CI walked with an antalgic gait, no heel to toe roll, flat foot strike and limited stance phase on the right foot.  At an evaluation on 13 October 2005, the CI presented with intense pain in her right heel, painful walking and sharp pains to the area intermittently.  No associated physical examination documentation was found in the CI’s file.  At a clinical appointment on 21 November 2005, the CI complained of pain with no improvement with “use of boot.”  Physical examination found tenderness to palpation at the central part of the plantar fascia origin and fat pad atrophy (loss of fascia tissue) to the area.  Magnetic resonance imaging (MRI) studies of the right foot performed on 5 January and 10 February 2006 demonstrated inflammatory change on the internal short flexor of the toes connecting to the plantar fascia and mild planter fasciitis of the medial attachment of the plantar aponeurosis, although tarsal tunnel syndrome was not excluded.  At an orthopedic examination on 17 April 2006, the CI complained of pain in the right heel. Physical examination showed tenderness at the origin of the right plantar fascia.  On 24 May 2006, the CI underwent a second operation of the area due to an incomplete release of the plantar fasciae. The CI was informed of the risks and benefits of the surgery, in particular the risk of persistent pain.  At an orthopedic follow-up visit on 27 July 2006, the CI complained of “pain in the heel and some “weird” feelings.” Physical examination found tenderness to palpation with areas of numbness around the surgical scar.  The examiner noted that the pain from the plantar fascia release was “likely secondary to neural injury.”  At a physical therapy appointment on 7 August 2006, the CI complained of constant sharp shooting pins and needles pain in her right foot plantar area.  She stated that it was the “worse pain in 3 days.”  The CI said the pain was aggravated with walking and relieved with rest.  ROM of the right foot showed right ankle dorsiflexion was 5 degrees and plantar flexion was 46 degrees.  The examiner noted diffuse tenderness to palpation at the right heel.  At an orthopedic follow-up examination on 28 August 2006, the CI complained of sharp, non-radiating pains that woke her up at night.  Physical examination showed the right heel area was tender over the surgical scar and a negative Tinel’s sign was elicited.  At an orthopedic appointment on 18 September 2006, the CI complained of continuous pain in the right heel.  The examiner noted that there had been no improvements with the various treatment regimens and modalities.  The CI was observed to ambulate with the assistance of a controlled ankle movement (CAM) brace.  Physical examination findings showed tenderness to palpation at the plantar heel and origin of the plantar fasciae.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 25 October 2006, 4 months prior to separation, the CI reported chronic plantar fasciitis of the right foot.  The examiner noted the same. There were no physical examination findings annotated.  The MEB NARSUM examination on 8 November 2006, 4 months prior to separation, noted complaints of right heel pain, inability to stand for prolonged periods of time, walk long distances or run.  Physical examination showed her right heel pad was atrophic (loss of fascia tissue), tenderness at the origin of the plantar fascia. The examiner noted a negative Tinel’s sign at the tarsal tunnel. There was normal sensation, strength to the foot, flexion, and extension of the toes and ankle.  The examiner noted flat feet bilaterally.  

At the 2 June 2007 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported a 5/10 sharp constant pain in the right heel.  The CI admitted to pain with ambulation, had two right heel surgeries, and used corrective shoes and various medications to control the pain. The CI stated that the foot problem did not affect her occupation.  Physical examination showed the CI had flat feet and pain with palpation to the plantar arch and heel.  The CI demonstrated normal gait, Achilles tendon alignment with and without weight bearing, and forefoot and midfoot alignment.  At a primary care clinic appointment on 6 July 2007, performed 4 months after separation, the CI presented with worsening chronic pain to the right foot.  The CI described the pain as constant, sharp and shooting. The pain is a 5/10 without medications and 8/10.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot plantar fasciitis condition 0%, coded analogously as 5399-5310 (Group X. Function, foot), citing Table of Analogous Codes as Group X muscle injury, slight.  The VA also rated the right foot plantar fasciitis condition 0% coded analogously as 5299-5276 (acquired flatfoot), based on the VA C&P examination 3 months after separation, citing mild symptoms.  The Board noted subjective reports of pain with use and objective findings of tenderness to palpation.  There was also atrophy of the right heel pad.  The CI’s initial procedure for this condition was in June 2005.  The CI was given various treatment modalities, including cortisone injections to the area to relieve the pain after the initial surgery.  Subsequently, the CI suffered from atrophy to the plantar aspect of the right foot.  The CI continued having sharp shooting persistent pain to the area even after the second surgery to correct the deficits from the initial surgery.  Various treatment modalities, including physical therapy, medicinal and the use of a CAM walker boot had not alleviated the pain to the plantar aspect of the right foot, especially when the CI walked.  The orthopedic surgeon informed the CI that one of the risks was persistent pain.  The atrophy to the plantar area of the right foot (loss of fascia tissue) had not resolved and the pain persisted.  Board members agreed that the evidence supports a rating of 10% for moderate plantar aponeurosis functional impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right foot plantar fasciitis condition, coded 5399-5310.  

BOARD FINDINGS:  In the matter of the right foot plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5310 IAW VASRD §4.73.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	
Plantar Fasciitis Right Foot	5399-5310	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004617, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

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,
Enclosure