RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00309
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “bilateral plantar fasciitis with underlying condition of pes planus” and “bilateral shin splints,” rated 0% each, with a combined disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  The 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 - 20040901	VARD - 20050518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis with underlying condition of Pes Planus	5399-5310	0%	Bilateral Pes Planus with history of Plantar Fasciitis	5276	0%	20041215	
Bilateral Shin Splints	5022	0%	Chronic Bilateral Shin Splints	5022	0%		
Left Hip Pain	Not Unfitting	No VA Placement	
Left Knee Pain	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis with underlying condition of Pes Planus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought medical attention on 12 January 2003 for a left foot injury he sustained 6 months earlier while carrying a 200 pound rucksack during a foot march.  The exam was not remarkable and he was diagnosed with shin splints.   The pain persisted and he was diagnosed with bilateral pes planus and treated with insoles.  He was eventually diagnosed with bilateral plantar fasciitis due to pes planus.  There was no surgical indication.  

The 21 July 2004 MEB NARSUM examination, 3 weeks prior to separation, noted complaints of chronic foot pain that had progressed to the left knee and hip.  The pain ranged from a constant 6-8/10 and was exacerbated by activity.  Physical examination showed moderate pes planus with tautness along the middle third of the plantar fascia without swelling or bruising.  

At the 15 December 2004 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported some arch pain.  He was given soft arch supports which helped and he no longer had pain in his arches.  He worked as a car salesman and was on his feet all day and was able to do so without limitations and no exacerbations.  He did not require a walking aide and had not missed work.  Physical examination showed no evidence of plantar fasciitis but there was moderate pes planus that was not causing him any difficulty.  
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, coded analogously to 5310 (group X function: movements of forefoot and toes), citing “slight.”  The VA rated the bilateral foot condition 0% coded 5276 (flatfoot, acquired: (pes planus)), based on the VA C&P examination 5 months after separation, citing “no objective evidence [of] significant functional limitation due to pain, weakness, fatigue, lack of endurance or incoordination.”

The STR evidence indicated both the right and left feet were equally symptomatic and both were profiled.  The symptoms and examination findings were essentially the same in both, with evidence of pes planus and plantar fasciitis of the right and left feet.  He was able to work and stand on his feet all day without worsening of pain and without exacerbations.  There was no evidence of painful or limited motion to justify a rating higher than 0%.  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 with pes planus. 

Bilateral Shin Splints.  According to the STR and MEB NARSUM, the CI first sought medical attention on 12 January 2003 as described above.  The shin splints persisted with the left tibia more painful than the right.  A 30 January 2004 bone scan of the lower extremities noted bilateral shin splints without stress fractures with a possible bony defect in the left medial femoral bone.  

The 21 July 2004 MEB NARSUM examination, 3 weeks prior to separation, noted complaints of bilateral leg pain exacerbated by infantry duties and his physical training.  Physical examination showed tenderness over the middle third of the tibial shaft bilaterally without swelling, bruising, deformity or vibratory pain.  His clinical and functional status was stable.  

At the 15 December 2004 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported that his shin splints had resolved after he decreased his level of activity and he was entirely asymptomatic.  Physical examination showed normal gait and normal joints without evidence of shin splints.  
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral shin splints 0%, coded 5022 (periostitis), citing “no significant loss of joint motion of the contiguous joints.”  The VA also rated the bilateral shin splints 0% coded 5022, based on the VA C&P examination 5 months after separation, citing “no objective evidence of painful or limited motion of the affected joints.”  The STR evidence indicated both the right and left lower extremities were equally symptomatic and both were profiled.  The symptoms and examination findings were essentially the same in both, with evidence of shin splints of the right and left legs.  

As noted in the NARSUM examination and confirmed by the C&P examination, duty limitations resulted in resolution of the shin splints.  The CI was able to work and stand on his feet all day without worsening of pain and without exacerbations.  There was no evidence of painful or limited motion to justify a rating higher than 0%.  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 shin splints.  

Contended PEB Conditions:  Left Hip Pain and Left Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis with pes planus condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the bilateral shin splint condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left hip and left knee conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160524, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
AR20170015263, 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,					      
						      					
Enclosure