RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01677
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Infantryman, medically separated for “chronic left plantar fasciitis” with a disability rating of 0%.

CI CONTENTION:  “I wasn’t given a fair rating, when other soldiers were getting higher ratings for the same thing.”  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 - 20051206	VARD - 20070509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Plantar Fasciitis	5399-5310	0%	Left Foot Pes Planus, Plantar Fasciitis	5276	10%	20070306	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Plantar Fasciitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left heel condition began in May 2004 without trauma or injury.  The condition was treated with foot injections, boot inserts and night splints without resolution of pain.

The 25 October 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic left heel pain.  Physical examination showed bilateral severe pes planus and left ankle tenderness.  There was no evidence of edema, erythema, warmth or muscle atrophy.  Ankle range of motion was full without laxity, instability, tenderness or edema; painful motion was not addressed.  There was normal lower extremity strength and sensation.  Left foot X-rays taken on 24 May 2004 and 9 May 2005 were normal.  Left foot weight bearing X-rays taken on 25 May 2005 showed mild pes planus.  

A podiatry evaluation on 11 January 2006, 9 days prior to separation, revealed bilateral ankle and foot tenderness.  Left foot plantar fasciitis testing elicited heel pain and left heel tenderness.  Bilateral dorsiflexion rendered painful motion.  A weight-bearing line over the medial to great toe and inward bowing of the tendo achillis were not addressed.

At the 6 March 2007 VA Compensation and Pension (C&P) examination, 14 months after separation, the CI reported left foot pain that was exacerbated by standing or walking, but he could walk up to 3 miles and stand for an hour.  Physical examination showed no swelling, heat, redness, stiffness, fatigability, weakness or lack of endurance.  The CI wore a semi-flexible orthotic device for his plantar fasciitis.  His gait was normal and non-weight and weight bearing testing was normal.  There was no left foot pain with manipulation.  X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 0%, analogously coded 5399-5310 (muscle group X (plantar fasciitis)).  The VA rated the left foot condition 10%, coded 5276, (flatfoot, acquired (pes planus)), based on the C&P examination, citing objective evidence of left foot tenderness with use.

Panel members first considered a rating under code 5310.  A 10% rating for plantar muscles requires “moderate” symptoms consisting of loss of power, weakness, lowered threshold of fatigue, fatigue-pain, and impairment of coordination and uncertainty of movement.  The panel agreed the STR did not document evidence of “moderate” symptoms at the time of separation.  The panel also considered code 5276 but found no STR evidence of weight-bearing line over the medial to great toe nor inward bowing of the tendo achillis to support a minimum 10% rating.  The panel reviewed alternative VASRD foot and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left plantar fasciitis condition.

BOARD FINDINGS:  In the matter of the left plantar fasciitis condition and IAW VASRD §4.73, the panel 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 20170303, w/atchs
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Record

AR20180008159, 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