RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01507
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040726

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

CI CONTENTION:  His PTSD is worse and he is going blind.  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 (VA), 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 - 20040524	VARD - 20080609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Heel Pain	5099-5003	0%	Osteoarthritis of Both Heels	5010	10%	20080117	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Bilateral Heel Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in podiatry on 2 December 2002 for a 4 month history of bilateral heel pain which began in December 2002.  The CI was undergoing an assessment for diabetes mellitus (DM) and under treatment for dry skin, a fungal infection, and a neuropathy.  There was no history of an injury.  He was thought to have plantar fasciitis and treated with a brace, shoe of comfort, and arch supports.  He was next seen in podiatry on 12 June 2003 when he reported that he had twisted his left ankle the week before.  X-rays showed bilateral heel spurs which are associated with plantar fasciitis.  Two weeks later he was evaluated in the VA podiatry clinic where he reported that his heel pain was aggravated by walking on concrete floors all day; the CI had been released from active duty and was back at his civilian job as a meat cutter.  In podiatry on 8 September 2003, the CI reported improvement in his symptoms but he could not meet full duty requirements and requested an MEB.  His condition was thought to be resolved.  

The 22 September 2003 MEB NARSUM examination, 10 months prior to separation, noted complaints of pain in both feet with prolonged standing.  An evaluation for possible vascular disease as a cause of the pain was negative.  The range of motion (ROM) of the ankles was noted to be reduced, but no comment was made on the arches or plantar fascia.  He was thought to have osteoarthritis of both heels causing the pain.  During the 25 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the physical examination showed a normal arch and feet.  The CI did not report foot pain in the history.  The addendum to the NARSUM on 5 May 2004 had no notes regarding the feet.  

There was no VA Compensation and Pension (C&P) evaluation in evidence proximate to separation.  However, the CI was seen in the VA podiatry clinic on 7 April 2005, 7 months after separation.  The CI reported no complaints at that time.  On examination, he was noted to have full ROM, thickened skin, and a fungal infection.  No comment was made on the gait, heels (other than thickened skin), or plantar fascia.  The CI was observed to have poor hygiene of the feet.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral heel condition 0%, coded analogously as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the bilateral heel condition 10%, coded 5010 (traumatic arthritis), based on the C&P examination 3 1/2 years after separation, citing X-ray evidence of bilateral heel spurs with occasional incapacitating exacerbations.  The PEB unfitting diagnosis was chronic bilateral heel pain, a symptom rather than a diagnosis.  X-rays were noted to show heel spurs, associated with plantar fasciitis.  However, the foot condition was thought to be resolved in the final military podiatry evaluation prior to separation.  The panel found no diagnosis upon which to base a recommendation for a higher rating.  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 heel condition.  

BOARD FINDINGS:  In the matter of the bilateral 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.  Therefore, the panel 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 20160920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001636, 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