RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02209
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Intelligence Analyst, medically separated for “bilateral plantar fasciitis and heel spurs,” rated 10% each foot, with a combined disability rating of 20%.  

CI CONTENTION:  “I believe this condition is a symptom of a back injury sustained in 2008 in Germany.  As well as this condition has limited my ability to run increasing my chances for weight gain thereby exacerbating the condition.”  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 - 20090505	VARD - 20090730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis and Heel Spurs	5299-5284	20%	Bilateral Plantar Fasciitis	5276	10%	20090708	
Low Back Pain	Not Unfitting	Herniated Disc L4-L5	5243	10%	20090708	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis and Heel Spurs.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s foot conditions began in November 2007 after a long run.  X-ray documented inferior and posterior calcaneal spurring of both feet.  The left heel pain decreased following custom orthotics, but the right foot was constant at 7/10, and the CI was unable to wear combat boots or perform activities including prolonged walking.  

The 16 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, revealed over pronation and calcaneal tenderness.  The 3 February 2009 physical therapy (PT) ankle range of motion (ROM) evaluation, 5 months prior to separation, documented a mildly antalgic gait attributed to back pain and not foot pain.  Left and right ankle ROM testing showed dorsiflexion of 6 degrees on the left and -2 degrees on the right (normal 20) and plantar flexion of 42 on the left and 45 on the right (normal 45) with limitation due to pain.  There was moderate deformity over the posterior calcaneus at the insertion of the Achilles tendon.  The examiner indicated that pain caused “interference with standing and weight bearing of the bilateral lower extremity.”  During the 30 March 2009 MEB NARSUM examination, 3 months prior to separation, the CI reported that he could not carry anything or walk like everybody else and had heel and foot pain.  Physical examination showed the CI was wearing custom orthotics in both tennis shoes.  Gait was unremarkable; however, after standing at attention for approximately 5 minutes, the CI demonstrated an antalgic gait and was noted to avoid dorsiflexion and plantar flexion of the right ankle during ambulation.  The feet had no deformity, discoloration, ulcer, edema or change in temperature.  There was hyperkeratosis consistent with a callus over the medial aspect of the third left and fourth right toes without other skin lesions.  There was marked tenderness to very light palpation over the medial and central region of the calcaneus at the plantar aspect bilaterally.  The examiner indicated that baseline heel pain had improved with sedentary work, but that bilateral heel spurs prevented the CI from standing and performing in his primary MOS.  

At the 8 July 2009 VA Compensation and Pension (C&P) examinations, 1 month after separation, the CI reported bilateral plantar fasciitis with soreness and tenderness in the feet.  Wear of inserts helped to some degree.  Physical examination showed a normal gait with warm feet.  Bilateral lower extremities were without edema or atrophy.  Strength, skin, sensation, pulses, capillary refill and reflexes were normal.  There was bilateral plantar fascial tenderness and soreness.  The CI could stand and walk, raise on his toes and heels, but pain was noted.  There were no other weightbearing abnormalities, and X-rays of the feet documented spurs.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot conditions 10% each foot, analogously coded 5299-5284 (foot injuries, other), citing moderate bilateral foot impairment.  The VA rated the bilateral foot condition 10%, coded 5276 (flatfoot, acquired), based on the C&P examination, citing tenderness and soreness in both feet and pain on manipulation and use of the feet.  The panel agreed that the foot examinations proximate to separation were consistent with the “moderate” (10%) foot injury (5284) disability level for each foot.  Although the PT ankle ROM evaluation may have supported a higher rating, it was the only ankle evaluation, was less proximate to separation and did not align with the disability level in the preponderance of the record and was therefore considered to be an outlier.  There was insufficient evidence that either foot more nearly approximated the severe pes planus criteria.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all 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 condition.  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended back 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.  

	

AR20190009123, 

Dear XXXXXXXXXXXXXXXXXXXX

	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.