RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01981
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Unit Supply Specialist, medically separated for “left heel pain” with a disability rating of 10%.  

CI CONTENTION:  The CI requested review of his heel pain 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 - 20051004	VARD - 20060403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Heel Pain	5099-5002	10%	Bilateral Planter Fasciitis	5276	10%	20060126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Heel Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the first record in evidence for the left foot condition was dated 1 February 2004.  The CI reported a 2-week history of left heel pain without recorded trauma.  He was treated with medications and continued on a permanent profile (for shin splints).  The next record was dated 15 September 2004; the CI reported longstanding left heel pain and was thought to have plantar fasciitis.  He was treated with medications, duty limitations, and shoe inserts, but his pain persisted.  X-rays of the left foot on 13 April 2005 were normal.  A bone scan 2 weeks later showed findings compatible with a left Achilles tendinitis and an injury of or near the medial malleolus (inside ankle bone).  

Repeat X-rays of the feet on 19 August 2005 were normal although subsequently he was thought to have reactive changes at the Achilles tendon insertion (it is not clear if this was a later review by orthopedics or additional X-rays).  The CI was seen the same day in orthopedics.  It was noted that he had remained in constant pain despite treatment and could not meet full duty requirements.  On examination, the heel and foot were tender, but the examination was otherwise unremarkable.  The gait and stance were recorded as “normal foot and ankle.”  He was diagnosed with tendonitis of the left Achilles and referred for an MEB.  

During the 22 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported constant left heel pain which was aggravated by prolonged standing.  An MRI of the ankle on 15 September 2005 was normal and without a stress fracture of the heel bone.  The 19 September 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of the ongoing heel pain for one year despite treatment.  The physical examination showed pain to deep palpation of the heel, but not the Achilles tendon.  He could heel and toe walk without significant difficulty.  The range of motion (ROM) was noted as normal compared to the right, but was less than the VA normal values with dorsiflexion (toes up) of 10 degrees (normal 20) and plantar flexion (toes down) of 30 degrees (normal 45).  He was diagnosed with chronic left heel pain recalcitrant to treatment.  

At the 26 January 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported foot pain aggravated by activity and prolonged standing.  The physical examination showed a normal gait and stance without the use of an assistive device.  Tenderness of the left foot was present, but the ROM of the ankles was normal and flat feet were not present.  X-rays were normal.  The CI was diagnosed with bilateral plantar fasciitis based on tenderness of both feet and normal X-rays.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left heel condition 10%, analogously coded 5099-5002 (arthritis rheumatoid), citing slight and frequent pain (language of the US Army Physical Disability Agency pain policy, although the policy was not specifically cited).  The VA rated the left foot condition 10%, coded 5276 (flatfoot, acquired), based on the C&P examination, citing pain on manipulation and use of the feet.  

The panel observed that the CI was noted to have reactive changes on review of one X-rays series near the insertion of the Achilles tendon, but multiple other X-rays and an MRI were normal.  A bone scan had been consistent with inflammation of the Achilles tendon.  The ROM was less than the VA normal values on one orthopedic examination, but was noted to be normal.  The VA examination did show normal ROM.  The panel also observed that the minimum rating under the code 5002 used by the PEB is 20%, but code 5002 is for rheumatoid arthritis, a systemic rather than a localized condition such as is the case here.  The panel noted that the code 5024 (tenosynovitis) is a better clinical fit for at least some of the examinations, but provided no rating advantage to the CI as no more than a 10% rating is supported.  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 heel condition.  

BOARD FINDINGS:  In the matter of the left heel condition and IAW VASRD §4.71a, 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 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008657, 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