RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00383
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060617

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Trainee, medically separated for “chronic bilateral foot pain” with a disability rating of 0%.   

CI CONTENTION:  Review requested of foot condition and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060426	VARD - 20061205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5399- 5310	0%	Plantar Fasciitis, Bilateral	5299-5276	10%	20061023	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Bilateral Foot Pain.  The PEB combined the bilateral plantar fasciitis condition under a single disability rating, coded analogously to 5310 and rated 0%.  This 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 panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel 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 panel 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 MEB narrative summary (NARSUM), the CI first noticed bilateral foot pain after a ruck march during basic training in late 2004.  Orthopedic examination on 14 December 2005, showed tenderness along the mid foot, arches, and plantar fasciae, which was mildly exacerbated with dorsiflexion of the foot and extension of the toes.  On 19 December 2005, an MRI interpreted by an orthopedic surgeon showed findings consistent with chronic plantar tendinopathy.  

The 27 February 2006 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of foot soreness with sharp and sometimes searing pain in both heels and along the plantar surfaces.  The pain was constant and worsened with activity and standing longer than 5 minutes.  Physical examination showed mild pes planus and tenderness with deep palpation at the insertion of plantar fascia bilaterally.  A podiatry evaluation on 22 May 2006 noted right foot pain greater than on the left, and physical examination demonstrated restricted ankle motion and a positive Tinel’s sign for tarsal tunnel syndrome.  

At the 23 October 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported bilateral foot pain which increased with the first step of the morning and getting up after periods of rest; he wore custom orthotics and night splints.  Physical examination showed a normal gait and pain with palpation of the plantar arch and medial calcaneal tubercle bilaterally, positive Tinel’s sign at the left tarsal tunnel, and ankle dorsiflexion to 8 degrees bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, analogously coded 5399-5310 (foot group X), citing mild tenderness of the plantar fascia.  The VA rated the bilateral foot condition 10%, analogously coded 5276 (acquired pes planus), based on the C&P examination, citing pain on manipulation and use of the feet. 

The panel first considered whether each foot, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The commander’s statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either foot over the other.  Since undue speculation would be required to conclude that impairment from either foot would not have unacceptably interfered with the performance of military duties, members agreed that each foot was reasonably justified as separately unfitting. Under VASRD code 5310, foot muscle dysfunction is rated from mild to severe, and members agreed that reports of a normal gait, pain with use, and objective findings of tenderness at the plantar surface warranted a 0% rating for mild muscle dysfunction.  When considering a rating analogous to 5020 (synovitis) based on limitation of motion, the panel concluded that the preponderance of evidence did not support moderate ankle limitation of motion or painful motion for a 10% rating.  However, members agreed that evidence of pain on manipulation and use of feet warranted a 10% rating analogous to 5276 (bilateral or unilateral).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a single disability rating of 10% for the bilateral foot condition, coded 5299-5276.  

BOARD FINDINGS:  In the matter of the chronic bilateral foot pain, the panel recommends each foot as unfitting and a 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Bilateral Foot Pain	5299-5276	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012738  XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

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.