RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01807
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve 03, Chemical, Biological, Radiological and Nuclear Officer, medically separated for “painful feet…pes cavus and plantar fasciitis” with a disability rating of 0%.  

CI CONTENTION:  He contended multiple conditions and requested review of 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 - 20041103	VARD - 20050615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful feet…Pes Cavus and Plantar Fasciitis	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5276	10%	STR	
			Pes Cavus	5278	0%		
Subjective Hearing Loss	Not Unfitting	Hearing Loss	6100	NSC		
Right Shoulder Bursitis/Tendonitis	Not Unfitting	Right Shoulder Impingement Syndrome	5201	0%		
Lower Back Pain	Not Unfitting	Lower Back Pain	5237	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Painful Feet…Pes Cavus and Plantar Fasciitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the first clinical entry documenting the CI’s painful foot condition was on 23 January 2003, when he reported bilateral atraumatic foot pain for one day which was similar to an episode 3-4 years earlier.  He was thought to have plantar fasciitis and treated with medications and orthotics, as well as duty limitations.  His pain persisted, and on 24 February 2004, a podiatrist diagnosed pes cavus and he was as referred to physical therapy and issued custom arch supports.  At an orthopedic visit on 5 April 2004, bilateral dorsiflexion was to 20 degrees (normal), and bilateral plantar flexion was to 40 degrees (normal 45).  The plantar fasciae were tender, but the arches were normal. The CI declined injections and surgery.  

During the 14 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bilateral plantar fasciitis which limited standing and walking, but the provider recorded “normal” feet.  The MEB NARSUM examination, on the same day, documented complaints of bilateral foot pain which prevented “long periods of standing, any distance walking, or any running.”  The examiner documented that the CI aggravated his foot condition after a bad landing in airborne training on 22 January 2003 and noted he had gained 40 pounds since accession.  Physical examination revealed a normal gait with no abnormal foot placement when standing.  Moderate pes cavus was observed while seated, and the feet were tender along the plantar fasciae and arches as well as all the metatarsal-phalangeal joints and distal metatarsals over the dorsal aspect.  The range of motion measurements from the orthopedic appointment were repeated.  The provider remarked that previous X-rays in July 2003 and April 2004 showed normal feet, except for a soft tissue bunionette of the left foot, and diagnosed plantar fasciitis and pes cavus.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the plantar fasciitis and pes cavus conditions as “painful feet” rated at 0%, analogously coded 5399-5310 (Group X function: movements of forefoot and toes), citing an inability to fully perform military specialty duties due to foot pain and tasks in the field because of a restrictive profile.  The VA rated the bilateral plantar fasciitis condition 10%, analogously coded 5299-5276 (flatfoot, acquired) based on the STR examination, citing “great pain from manipulation and use of feet.”   The VA also rated the pes cavus condition 0%, coded 5278 (claw foot, acquired) based on the STR examination, citing tenderness but full dorsiflexion.  

The PEB combined the plantar fasciitis and pes cavus conditions for rating.  Both were found to be medically unacceptable, but only the plantar fasciitis was profiled and specifically commented upon by the commander.  Members noted the arch and dorsiflexion were found to be normal at the April 2004 orthopedic appointment, and concluded that the preponderance of evidence supported that the pes cavus condition was not separately unfitting at separation.  The panel next addressed the bilateral plantar fasciitis and observed that the CI was consistently seen for both feet, which were profiled and found medically unacceptable, and also implicated by the commander.  The plantar fasciae were noted to be tender and plantar flexion limited by 5 degrees, however gait was normal.  Members determined that these facts were more consistent with a “slight” impairment rather than “moderate,” and that a 0% rating was appropriate for each foot; however, separate ratings provide no rating advantage to the CI.  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 painful feet condition.

Contended PEB Conditions:  Subjective Hearing Loss, Right Shoulder Bursitis/Tendonitis, Lower Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and all were judged to meet retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the painful feet condition and IAW VASRD §4.73 the panel recommends no change in the PEB adjudication.  In the matter of the contended subjective hearing loss, right shoulder bursitis/tendonitis, and lower back pain conditions, the panel recommends no change from the PEB determinations as not unfitting.  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.  

AR20180011416 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.