RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01827
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Radiology Specialist, medically separated for “bilateral plantar fasciitis” with a disability rating of 20%.  

CI CONTENTION:  “Multiple conditions identified by PEB were found to be service-connected by Department of Veterans Affairs.  Additional conditions, not identified by the PEB, were also found to be service-connected by the VA.”  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 - 20090716	VARD - 20091030	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5299-5284	20%	Bilateral Plantar Fasciitis	5276	10%	20090731	
Mild OSA	Not Unfitting	Sleep Apnea with CPAP	6847	50%	20090731	
Bilateral Knee Pain	Not Unfitting 	Right Knee Strain	5260	10%	20090731	
		Left Knee Strain	5260	10%	20090731	
Low Back Pain	Not Unfitting 	Lumbar DDD 	5242	20%	20090731	
Adjustment Disorder	Not Unfitting 	Adjustment Disorder	9440	10%	20090728	
Irritable Bowel Syndrome	Not Unfitting 	Gastroenteritis, Recurring	7399-7307	NSC	20090731	
MRSA	Not Unfitting 	Carrier of MRSA Staphylococcal	7820	NSC	20090731	
ADHD	Not Unfitting 	ADHD	9410	NSC	20090728	
Alcohol Disorder	Not Unfitting 	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began in 2005 without trauma or injury.  On 15 April 2007, diffuse tenderness was present over both feet, but weight bearing radiographic studies were normal.  A formal PEB found him fit for duty on 5 September 2008.  On 18 February 2009, imaging studies showed bilateral pes planus with bilateral mild degenerative changes in the first metatarsophalangeal joint.  On 23 February 2009, at a primary care appointment his gait was normal.  One month later in family practice, the CI was again noted to have a normal gait, but podiatry noted tenderness over the plantar fascia.  

The 1 April 2009 MEB NARSUM examination, 6 months prior to separation, showed a normal gait with tenderness to the soles of the feet.  In physical therapy on 8 April 2009, the gait was normal although heel to toe walking was difficult due to the pain from the plantar fascia.  At the 11 June 2009 podiatry examination, the CI had tenderness over the plantar fascia bilaterally and flexible flat feet (pes planus).  On 17 June 2009 an addendum to the NARSUM, 4 months prior to separation, noted ongoing bilateral foot pain.  On physical examination, the gait was normal including heel and toe walk, but the latter were with pain.  Bilateral tenderness over the plantar fascia was present as was mild flexible pes planus.  

At the 31 July 2009 and 26 August 2009 VA Compensation and Pension (C&P) evaluations, 3 and 2 months before separation, the CI reported partial benefit with the use of orthotics (shoe inserts).  On examination, the gait was normal and evidence of unusual shoe wear was absent.  The plantar fascia were tender bilaterally.  Bilateral mild pes planus was present on the July examination, but not on the August evaluation.  X-rays of the feet at the latter examination were normal both with and without weight-bearing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis 20% (10% each foot), coded 5299-5284 (analogous to other foot injuries).  The VA rated the bilateral plantar fasciitis condition 10%, coded 5276 (pes planus), based on the C&P examinations, citing painful motion.  Although tenderness was consistently recorded, so was a normal gait.  X-rays were typically normal and the one X-ray that showed degenerative changes, was followed by normal X-rays.  The panel found no higher rating than the 10% adjudicated for each foot by the PEB.  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 bilateral plantar fasciitis.  

Contended PEB Conditions: Mild Obstructive Sleep Apnea (OSA), Bilateral Knee Pain, Low Back Pain (LBP), Adjustment Disorder, Irritable Bowel Syndrome (IBS), MRSA Infection, Attention Deficit Hyperactivity Disorder (ADHD) and Alcohol Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that these conditions were not unfitting.  The OSA was profiled and found to be medically unacceptable.  The commander noted that it precluded deployment.  The PEB specifically determined that the condition was not unfitting for the MOS of the CI even in a deployed environment, as power would be available.  Both the bilateral knee pain and LBP were included in the L3 profile, but found to meet retention standards.  Neither was specifically implicated in the commander’s statement.  The adjustment disorder, irritable bowel syndrome, MRSA infection, ADHD and alcohol disorder were noted to meet retention standards.  None were profiled or specifically implicated by the commander.  The PEB observed that the adjustment disorder, ADHD and alcohol disorder were conditions not constituting physical disabilities IAW DoDI 1332.38, enclosure 5.  There was no performance-based evidence from the record that any of these 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 determinations for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended mild obstructive sleep apnea, bilateral knee pain, low back pain, adjustment disorder, irritable bowel syndrome, MRSA infection, attention deficit hyperactivity disorder and alcohol disorder, the panel recommends no change from the PEB determinations as not unfitting.  There were 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 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004895, 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.

A copy of this decision has also been provided to the counsel you listed on you application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure