RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02005
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Graphic Arts Journeyman, medically separated for “bilateral heel pain, status post (S/P) bone spur excision both heels” with a disability rating of 20%.  

CI CONTENTION:  “Please review all conditions.”  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 - 20080325	VARD - 20090227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral [Left and Right] Heel Pain, S/P Bone Spur Excision Both Heels	5399-5311	10%	Bilateral Calcaneus with Post- Surgical Changes	5099-5020	10%	20081105	
		10%					
Obesity	Category III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Bilateral [Left and Right] Heel Pain, S/P Bone Spur Excision Both Heels.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s bilateral heel condition began in 2002.  He underwent removal of a bone spur within his left Achilles tendon in July 2003 and right Achilles tendon in September 2006; repeat surgery to his left heel was performed in January 2007.  Bilateral heel pain was not relieved.  The CI did not want to pursue further surgical intervention.

The 16 January 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of ongoing bilateral heel pain with any type of high impact activity.  Physical examination revealed bilateral point tenderness at the insertion of each Achilles tendon.  Bilateral plantar flexion and dorsiflexion were 20 degrees each (normal 45 and 20, respectively).

At the 9 October 2008 VA Compensation and Pension (C&P) Orthopedic examination, 5 months after separation, the CI reported bilateral foot pain with variable severity, frequency and duration.  Physical examination demonstrated a normal gait and bilateral heel tenderness.  Ankle range of motion and painful motion were not addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral heel pain condition 10% each, analogously coded 5399-5311 (muscle injuries foot and leg group XI propulsion, plantar flexion of foot).  The VA rated the bilateral heel condition 10%, analogously coded 5099-5020 (synovitis), based on the C&P General examination, citing 10% rating can be applied once to multiple joints if there is no limited or painful motion.  Members agreed examinations findings were best characterized by the group XI muscle injuries (5311) which include the muscles of the calf that combine to form the Achilles tendon and were most consistent with a “moderate” impairment for a 10% rating for each foot as adjudicated by the PEB.  There was no evidence of claw foot (5278), hammer toe (5282) or severe hallux valgus (5280) in either foot to justify a rating under those respective codes.  There were no fractures with nonunion (5283), metatarsalgia (5279), or acquired flat foot (5276) with pain on manipulation of or use to substantiate a 10% rating for either foot with those codes.  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 heel condition.

Contended PEB Condition:  Obesity.   Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.

BOARD FINDINGS:  In the matter of the bilateral heel condition and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  In the matter of the contended obesity condition, the panel agrees it cannot recommend it for additional disability rating.  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 20170407, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02005.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings