RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00083
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Infantryman, medically separated for “chronic bilateral foot pain due to plantar fasciitis”, with a disability rating of 0%.  

CI CONTENTION:  The CI requested a review of 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 - 20031107	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain Due to Plantar Fasciitis	5299-5276
5399-5310	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain Due to Plantar Fasciitis.  The PEB adjudged the bilateral foot condition as a single unfitting condition coded 5299-5276 (flat foot, acquired) and 5399-5310 (Group X, Muscle), rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot pain condition began in March 2002 due to injury of his feet while deployed.  The pain was intermittent initially, but worsened to the point numbness in his feet with prolonged standing and road marching.  He was treated with injections, night splints and orthotics, without improvement sufficiently to allow full duty.  

The 19 August 2003 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic bilateral plantar fasciitis and foot pain and numbness with prolonged standing or road marching.  Physical examination showed normal strength, reflexes and neurologic testing of the extremities.  There was bilateral tenderness of the heels and forefoot with tenderness with dorsiflexion.  There was pes planus (flat foot – decrease of the normal arch) with circled entries on the DD Form 2808 (performed by the NARSUM physician) of “Pes Planus,” “Severe,” and “Symptomatic.”  X-rays of the feet were reported as normal.  The physician stated that the pain rating was “constant, slight.”   There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, coded 5299-5276 (flatfoot, acquired) and 5399-5310 (group X muscle), citing “slight.”    

Although rating under code 5310 is for each side separately, there was insufficient evidence of any muscle injury of either foot that could be rated higher than “slight” (0%) IAW VASRD §4.73 (schedule of ratings–muscle injuries), §4.55 (principles of combined ratings for muscle injuries, and §4.56 (evaluation of muscle disabilities).  Rating IAW VASRD §4.71a (schedule of ratings–musculoskeletal system) under code 5276 (flatfoot, acquired) is for unilateral or bilateral flatfoot.  The panel adjudged that there was no evidence of marked deformity, indication of swelling on use, or characteristic callosities to support either foot for rating as severe under code 5276 (the clinical finding of severe flattening of the arch does not equate to the severe flatfoot rating criteria).  However, the CI’s symptoms were not relieved by orthotics (built up shoe or arch support) and there was sufficient evidence of pain on manipulation of the feet to more nearly approximate the disability picture of the bilateral 10% rating criteria under code 5276.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bilateral foot condition, coded 5299-5276.  

BOARD FINDINGS:  In the matter of the bilateral foot condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel 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	
Chronic Bilateral Foot Pain Due to Plantar Fasciitis	5299-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151118, w/atchs
Exhibit B.  Service Treatment Record

AR20170013289, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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