RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02609
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Construction Equipment Repairer, medically separated for “bilateral heel pain” with a disability rating of 0%.   

CI CONTENTION:  “I am now rated 70% by the VA.  I had 3 surgeries on active duty.  They also did not give consideration for facial paralysis and tendonitis.  Additionally, I feel that my feet alone warranted a higher rating.”  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 - 20050927	VARD - 20060508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Heel Pain	5099-5003	0%	Bilateral Insertion Achilles Tendonitis with Residual
Haglunds Deformities	5299-5276	10%	20060415	
Residual Pain from Accessory Navicular Excision	Not Unfitting					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Heel Pain.  The PEB combined the right and left heel conditions as a single unfitting condition coded analogously to 5003 (arthritis, degenerative) and rated 0%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel also noted that “bundling,” the combining of two or more major joints may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left heel conditions are presented together, with attendant recommendations regarding separate unfitness and rating in the rating discussion.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral heel pain began in June 2004 and was associated with local swelling, redness and blisters whereby such symptoms were aggravated by wearing combat boots.  Radiographs taken in September 2004 revealed Haglunds deformity (bony enlargement on the back of the heel), bilaterally.  The CI underwent two separate surgical excisions of the deformities on 19 November 2004 (right heel) and 6 April 2005 (left heel), but continued to have bilateral heel pain afterwards.

The 16 September 2005 MEB NARSUM examination, 2 months prior to separation, noted the CI’s inability to run or perform any kind of strenuous activities with her lower extremities.  The physical examination (PE) revealed significant tenderness over the back of each heel near the insertion of the Achilles tendon.  Ankle and foot range of motion was “full and symmetric,” and peripheral sensation was normal.  The diagnosis was “residual pain from excised Haglund deformities.”

At the 14 April 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported having bilateral foot pain with walking and occasionally with sitting, but that the foot problems did not affect daily activities.  The PE revealed bilateral high-riding arches and posterior heel tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral heel pain 0%, analogously coded as 5003 citing slight, intermittent pain with application of the US Army Physical Disability Agency pain policy.  The VA rated the bilateral heel pain 10%, analogously coded as 5276 (acquired flatfoot), based on the C&P examination, citing the weight-bearing line over or medial to the great toe.  Panel members first agreed that it would be purely speculative to conclude that the disability confined separately to either foot would have rendered the CI incapable of performing within her occupational rating.  Additionally, members agreed it was also reasonable to surmise that it was the combined effect of both feet which rendered her unfit for duty.  After extensive deliberation, the panel concluded that the bilateral diagnosis of residual pain from excised Haglund deformities [bilateral heel pain] was properly captured and represented by the PEB’s VASRD analogous code of 5099-5003, and that the minimal adverse PE findings (not causing an adverse impact on daily activities) would not reach any level of a positive VASRD rating impairment.  Pursuant to the above rationale coupled with the consideration of the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel members agreed that a disability rating of 0% for the bilateral heel condition was appropriately recommended in this case.  

Contended PEB Condition:  Residual Pain from Accessory Navicular Excision.  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 or near 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 heel pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended residual pain from accessory navicular excision, the panel recommends no change from the PEB determination as not unfitting.  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 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008062, 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.