RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00325
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080412

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

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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20080317	VARD - 200140311	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	Plantar Fasciitis	5099-5020	NSC	VA Treatment Records	
Depression	Not Unfitting	Acquired Psychiatric Condition to include Post-Traumatic Stress Disorder (PTSD), Bi-Polar Disorder and Sexual Traumatization	9411	NSC		
Borderline Personality Disorder	Not Compensable					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s foot conditions began prior to activation in April 2007, when she stepped on a thorn injuring her left heel.  She was seen in Germany in September 2007 and was treated with orthotic devices, physical therapy and heel injections with some benefit.  At the 19 November 2007 MEB podiatry NARSUM examination, 5 months prior to separation, the CI noted pain to the arch area with standing, walking, jumping and running.  The examiner stated she was able to do the bike and the Army Physical Fitness Test (APFT).  Physical examination showed no evidence of an inflammatory process or vascular compromise in either foot.  Heel joint range of motion (ROM) demonstrated 3 degrees of inversion and 10 degrees of eversion, bilaterally.  The examiner noted the CI’s profile allowed the use of a bike for the alternate APFT event and no standing over 15 minutes at a time.  The CI was able to wear boots.  The examiner assessed pain as slight and occasional. 

During the MEB examination (recorded on DD Form 2808, 2807) dated 20 December 2007, 4 months before separation, the CI reported she had foot pain due to plantar fasciitis.  Physical examination recorded tenderness to palpation of medial heels and normal arches.  There was no VA Compensation and Pension (C&P) examination in evidence proximity to separation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition 0%, analogously coded 5310 (group X), citing normal imaging and examination and rated for slight injury.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 the panel must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for service rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  

The commander’s statement, was written 4 months before separation, and documented that the CI was unable to perform her duties of operating all wheel vehicles and equipment over varied terrain due to her chronic bilateral foot pain.  The commander noted that her limitations had an adverse impact on the unit’s readiness and the safety of herself and fellow soldiers.

The panel then proceeded to the rating of the right foot condition.  The MEB physical examination recorded mild tenderness to palpation of the right heel and no other symptom.  The podiatry addendum did not address the foot separately, and did not record the presence of pain or tenderness during the examination.  The panel also noted the absence of documentation related to the treatment of the right or left foot, in the STR.  The panel agreed that the preponderance of evidence did not support a compensable rating under code 5310 or any other applicable VASRD code.  

The panel next proceeded in rating of the left foot condition.  The podiatry addendum did not separate the feet.  There was no evidence for inflammation, and no disturbance of vascular or motor function in either foot.  It was noted that the CI was able to wear boots, but she was unable to stand for long periods of time.  There was no documentation of pain on motion, or foot tenderness.  There were no abnormal radiographic findings in either foot.  After deliberation, the panel concluded the record in evidence did not support the minimal compensable rating for left foot pain under any VASRD coding.  

The panel agreed neither the left foot nor the right foot condition rose to a level of compensability under §4.59, §4.45 or §4.40.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB adjudication for the bilateral plantar fasciitis condition. 

Contended PEB Conditions:  Depression and Borderline Personality Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The depression condition was profiled, but neither conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  Borderline personality disorder is a condition that does not constitute a physical disability.  The panel therefore has no reasonable basis for recommending these conditions as additionally unfitting for separation rating.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended depression and borderline personality disorder conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting. There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160521, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015279  , 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