RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01644
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Psychological Operations Specialist, medically separated for “bilateral plantar fasciitis” with a disability rating of 0%.  

CI CONTENTION:  “While some of my foot pain may be explained by the medical discharged diagnosis of plantar fasciitis, I continue to have pain that is not treated via the plantar fasciitis diagnosis recommendations: nor typical plantar fasciitis pain.  I have had this pain since my injury at AIT.”  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 Medical Evaluation Board (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 - 20040803	VARD - 20050119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	Plantar Fasciitis, Left Foot	5099-5020	10%	20040907	
			Plantar Fasciitis, Right Foot	5099-5020	10%	20040907	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis (PF).  The PEB combined the left and right foot PF conditions as a single unfitting condition coded 5399-5310 (analogous to moderate Group X muscle injury, includes plantar fascia) 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 the PEB’s approach of 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.  The evidence for the bilateral PF conditions is presented below.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral PF began after a 5-mile road march during advanced individual training in 2003.  Conservative care, including injection therapy and casting, provided only temporary relief.  At a podiatry visit on 4 May 2004, the CI stated that despite orthotics, she could not stand longer than 10 minutes or walk greater than a mile without foot pain.  Physical examination showed a slightly antalgic gait and full range of motion (ROM) at the ankle joints.  The 27 May 2004 permanent profile listed chronic PF, and the commander’s statement on 3 June 2004 implicated the PF condition as impairing successful performance of military specialty duties.  

The 4 May 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of bilateral foot pain exacerbated by running, marching, standing or any weight bearing activity.  Physical examination showed no edema or numbness of the feet, but there was pain with direct pressure on the plantar aspect of both heels.  

At the 7 September 2004 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported chronic bilateral foot pain at rest, and additional weakness, swelling and fatigue with activity.  She did not require assistive devices for ambulation or any type of orthotic support in her shoes, and had not lost any time from work due to her symptoms.  Physical examination revealed bilateral foot tenderness, but no signs of abnormal weight bearing or pes planus, and no limitation with standing or walking; gait and posture were within normal limits.  Bilateral foot X-rays were unremarkable.  

The panel first considered whether the left and right foot, having been de-coupled from the combined PEB adjudication, each remained separately unfitting as established above.  The permanent profile and commander’s statement both implicated PF, and the MEB NARSUM examiner diagnosed PF of both feet.  Panel members agreed there was not a preponderance of evidence to overcome the presumption that the functional limitations of the PF condition of each foot contributed to the CI’s inability to perform her military duties; and, accordingly separate disability ratings are recommended.  

The panel directed attention to its rating recommendation based on the above evidence.  As mentioned above, the PEB rated the bilateral PF foot condition 10%, coded 5399-5310.  The VA rated the left and right foot PF conditions 10% each, both coded 5099-5020 (synovitis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  Members noted that the discrimination between the “moderate” and “slight” characterizations under code 5310 depends on the presence of at least one “cardinal sign or symptom” of muscle injury, specified as “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement” for moderate, as opposed to none for slight.  During the MEB NARSUM and VA examinations, there was tenderness of each foot, and the CI reported constant bilateral foot pain aggravated by weight bearing activities.  The panel agreed that this evidence supports a 10% rating for each foot, coded 5399-5310.  Members also considered other VASRD foot codes IAW §4.71a, but all were less applicable and/or not advantageous for rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left PF condition, and 10% for the right PF condition, both coded 5399-5310.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis, the panel recommends an unfitting plantar fasciitis of the left foot and an unfitting plantar fasciitis of the right foot,  each rated 10%, and both coded 5399-5310 IAW VASRD §4.73.  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	
Plantar Fasciitis, Left Foot  	5399-5310	10%	
Plantar Fasciitis, Right Foot  	5399-5310	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011411, 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.

Sincerely,					      
Enclosure