RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02293
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060712

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O4, Infantry Officer, medically separated for “chronic back pain” with a disability rating of 0%.  

CI CONTENTION:  The CI received higher ratings from the VA for his service connected physical ailments.  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 - 20060530	VARD - 20061129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	0%	Degenerative Disc Disease, L4-L5 and L5-S1	5243	10%	20061002	
Plantar Fasciitis	Not Unfitting	Bilateral Pes Planus with Plantar Fasciitis 	5276	10%	20061011	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in April 1997, resolved and then was exacerbated in October 2002 after he was involved in a motor vehicle crash.  At the 11 January 2006 MEB physical therapy examination, 6 months prior to separation, the CI reported low back pain exacerbated by jumping, climbing, ruck marching, running, sit-ups or prolonged sitting.  Physical examination showed flexion to 75 degrees (normal 90) and combined range of motion (ROM) of 210 degrees (normal 240) without pain or muscle spasm.  Repeat physical therapy ROM testing performed 1 May 2006, 2 months prior to separation, showed flexion to 85 degrees and combined ROM of 200 degrees with painful motion noted.  

The 9 May 2006 MEB NARSUM, 2 months prior to separation, noted complaints of low back pain which limited lifting to 30 pounds, running to a half mile and marching or walking to two miles.  He was able to perform about 30 sit-ups before experiencing severe back pain and denied mechanical limitations to joint motions.  Physical examination was not performed.   

At the 11 October 2006 VA Compensation and Pension (C&P) orthopedic examination, 3 months after separation, the CI reported dull, achy back pain with occasional sharp shooting pain through both buttocks and the leg.  He wore a back brace when involved in work that included heavy lifting.  He reported he got flares once or twice each month associated with increased physical activity, farming, yard work or lifting heavy objects.  Physical examination showed normal gait, forward flexion to 80 degrees and combined ROM of 210 degrees, after repetition, with guarding and tenderness noted but no muscle spasms.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5299-5237 (analogous to lumbosacral strain), citing combined ROM of 240 degrees.  The VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of forward flexion.  

The panel agreed that a 10% rating was warranted for evidence of limitation of forward flexion, limitation of combined ROM or tenderness.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of IVDS with incapacitating episodes, which would provide for a higher rating under that formula (for IVDS).  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5299-5237.  

Contended PEB Condition:  Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The condition was profiled, implicated in the commander’s statement and judged to fail retention standards.  The CI was referred for a fitness for duty evaluation due to not being able to perform duties required of his MOS due to plantar fasciitis.  The panel concluded there was sufficient cause to recommend a change in the PEB fitness determination for the contended condition.  

According to the STR and MEB NARSUM, the CI’s plantar fasciitis began in 1996 without trauma.  In 2003 he was treated for right heel pain which resolved with orthotic shoe inserts by September 2003.  In February 2005 he was referred to podiatry for left heel pain.  His orthotics were checked for fit and function and he was treated with an anti-inflammatory medication.  Initially, his pain was slowly improving but in May 2005, it became more chronic.  

At the 15 December 2005 MEB podiatry examination, 7 months prior to separation, the CI reported bilateral foot pain that occurred with exercise.  The CI reported receiving injections into the right and left feet.  Physical examination revealed thickened plantar fascia of both feet with a normal arch.  Provocative testing for plantar fasciitis elicited no pain.  The podiatrist recommended against surgery.  

During the 1 May 2006 orthopedic evaluation, 2 months prior to separation, the CI reported bilateral foot pain and was not able to run more than one mile without severe foot pain.  There was no physical examination.  

At the VA C&P orthopedic evaluation, the CI reported dull, achy pain in both feet with occasional sharp, shooting pain.  He reported he was prescribed orthotic shoe inserts but did not bring them to the evaluation.  Physical examination showed a normal walking pattern.  There was tenderness along the plantar fascia bilaterally, left more than right.  There were no abnormal calluses or other evidence of abnormal weight bearing in either foot.  The foot arch was slightly lower than normal on both feet.  

The panel directed attention to its rating recommendation based on the above evidence.  The VA rated the bilateral plantar fasciitis 10%, coded 5243 (flatfoot, acquired), based on the C&P examination, citing weight-bearing line over or medial to the great toe with inward bowing of the tendo Achilles and pain on manipulation and use of the feet.  

The panel then considered if the right and left plantar fasciitis conditions, when de-coupled from the combined PEB adjudication, were separately unfitting.  Bilateral plantar fasciitis was listed on the permanent profile and the commander’s statement implicated both feet.  Review of the entire STR found that although at the time of separation the left foot was more symptomatic than the right, in the year prior to separation both heels were evaluated and treated with similar frequency.  The panel concluded there was not a preponderance of evidence in the service records, which overcame the panel’s presumption that the right and left plantar fasciitis conditions were reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting right and left plantar fasciitis conditions at the time of separation.

There was no evidence of acquired flat foot (5276), claw foot (5278), or severe hallux valgus (5280) in either foot to justify a rating under the respective codes.  There was no evidence of hammertoe (5282), fractures with malunion or nonunion (5283) or injuries to either foot that would be characterized as moderate (5284) to validate ratings under those codes.  There was no evidence of metatarsalgia to substantiate a 10% rating using code 5279, which specifies unilateral or bilateral.  Panel members agreed that the degree of disability displayed in the right foot condition was best characterized as slight and in the left foot, moderate, under code 5310 (group X muscle injury) for a 0% and 10% rating respectively.  After due deliberation, the panel agreed the preponderance of evidence with regard to the functional impairment of the right and left plantar fasciitis conditions favors its recommendation as additionally unfitting conditions for disability rating.  They are appropriately coded 5310 and meet the VASRD §4.73 criteria for a 0% rating for the right foot and a 10% rating for the left foot.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends a disability rating of 10%, coded 5299-5237.  In the matter of the contended bilateral plantar fasciitis condition, the panel agrees it was unfitting and recommends a disability rating of 0% right and 10% left, coded 5310 IAW VASRD §4.73.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5299-5237	10%	
Right Plantar Fasciitis	5310	0%	
Left Plantar Fasciitis	5310	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008661, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 Department of Veterans Affairs. 

Sincerely,					      
Enclosure