RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00393
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “chronic plantar fasciitis left heel” with a disability rating of 10%.

CI CONTENTION:  The condition continues to worsen.  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 - 20020614	VARD - 20031007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Plantar Fasciitis, Left Heel	5299-5284	10%	Left Plantar Fasciitis	5284	20%	20030811	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Plantar Fasciitis Left Heel.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic plantar fasciitis left heel condition began in May 2000 on deployment without trauma.  Left foot X-rays performed on 21 June 2001 showed a small bone spur of the heel.  Bone scan performed on 11 December 2001 showed nonspecific increased uptake in the left heel, possibly consistent with a stress reaction or stress fracture.  A surgical release of the plantar fascia of her left foot was performed 24 January 2002 but left heel pain continued after surgery.  The 14 June 2002 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic left heel pain, partially relieved with reduction of activities and anti-inflammatory medication.  Physical examination showed a well-healed surgical scar.  There was normal sensation and no evidence of posterior tibial nerve entrapment (tarsal tunnel syndrome).  Ankle ROM was dorsiflexion of 5 degrees (normal 20) and plantar flexion of 15 degrees (normal 45) and described as “unrestricted and pain free.”  Subtalar motion was also unrestricted, without pain.  There was tenderness to palpation of the proximal arch (site of PF insertion).  There was minimal discomfort with calcaneal compression (suggests no stress fracture).  Strength and sensation of the foot was normal.  At the 11 August 2003 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported left heel pain.  She reported she had trained herself to reduce the weight bearing on the heel with ambulation.  She was able to successfully work as a customer service representative which required sitting, standing, and walking.  Physical examination showed a normal gait.  There was point tenderness of the heel.  There was full ankle ROM with DF 20 degrees and PF 45 degrees, without pain, weakness, or fatigability with repetitive movement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic plantar fasciitis left heel condition 10%, coded 5299-5284 (analogous to foot injuries, other, moderate).  The VA rated the left plantar fasciitis condition 20% coded 5284 (foot injuries, other; moderately severe), based on the C&P examination.  The PEB assigned a 10% rating for moderate foot injury (coded 5284).  There was no evidence in record to support characterizing the foot injury as moderately severe for a higher rating under the 5284 code.  There was no evidence of flatfoot or claw foot deformity or malunion/non-union of tarsal/metatarsal bones to support a higher rating with other VASRD foot codes.  The panel also considered if rating the PF analogously to code 5310 (group X muscle injury (includes the PF) IAW VASRD §4.73 (muscle injuries) supported a higher rating.  A 10% rating could be achieved with code 5310 for moderate injury, but by similar reasoning as noted above for the code 5284 criteria, the evidence does not support rating the foot injury as moderately severe under this code.  There was therefore no higher rating available than 10% as adjudicated by the PEB.  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 plantar fasciitis left heel condition.  

BOARD FINDINGS:  In the matter of the chronic plantar fasciitis left heel condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20160614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00393.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings