RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02745
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Intelligence Analyst, medically separated for “bilateral foot pain” with a disability rating of 20%.  

CI CONTENTION:  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 - 20080924	VARD - 20090327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain 	5299-5284	10%	Left Plantar Fasciitis Status Post Surgery	5284	0%	20081021	
	5299-5284	10%	Right Plantar Fasciitis Status Post Surgery	5284	0%	20081021	
Prior Cholecystectomy	Not Unfitting	Vitamin D Deficiency Status Post Cholecystectomy	7318-7346	10%	20081021	
Vitamin D deficiency	Not Unfitting					
Hyperprolactinemia	Not Unfitting	Hyperprolactinemia	7916	NSC	20081021	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain due to Chronic Plantar Fasciitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent bilateral plantar fasciotomy surgery for recalcitrant plantar fasciitis.  Although her feet were still painful, the pain had somewhat improved.  During the 21 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported chronic bilateral foot pain aggravated by weight bearing activities and associated with swelling and redness.  Physical examination showed a normal gait.  The soles of her feet were tender and she was unable to toe walk.  The 25 August 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of discomfort on the ball of her feet.   The CI reported the inability to run or perform impact activities.  Physical examination showed a normal gait, despite tenderness of the soles of both feet and generalized tenderness under the heads of all the lesser metatarsals.  

Although the 21 October 2008 pre-separation VA Compensation and Pension (C&P) examination was not in evidence, the panel noted it was cited in the original 27 March 2009 VA Rating Decision, which showed a normal gait, despite tenderness to the soles of her feet and mild bilateral pes cavus.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left foot conditions 10% each, analogously coded 5299-5284 (foot injuries, other), citing “moderate” symptoms.  The VA rated the right and left foot conditions 0%, coded 5284 (foot injuries, other), based on the C&P examination, citing the absence of moderate symptoms associated with foot injury.  The panel agreed there was evidence to support characterizing each foot as moderate for 10% ratings.  The panel also agreed that neither foot rose to the level of moderately severe because the CI had a normal gait and there were no additional objective findings (such as redness, swelling, callosities or other foot deformities) to support the higher rating.  The panel considered other VASRD foot and analogous codes, but all were less applicable or not advantageous for rating of either foot.  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 foot condition.  

Contended PEB Conditions:  Prior Cholecystectomy, Hyperprolactinemia and Vitamin D Deficiency.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The CI had a history of an unusual gastric procedure including gastrectomy and cholecystectomy after which she lost a large amount of weight (the intended consequence).  Since that time she required a diet of meals at increased frequency and of small amounts.  At a gastrointestinal specialist visit on 25 March 2008 the CI requested an MEB due to her dietary restrictions which she reported were incompatible with deployment, although she had been deployed with the dietary restrictions and a P2 profile and tolerated it.  At a follow-up visit on 24 July 2008, 5 months prior to separation, after multiple imaging studies, the GI specialist concluded the CI had normal post-surgical anatomy and there was no intervention needed.  He indicated he did “not have a strong case of an MEB for her condition.”  The condition was not determined to fail retention standards.  Neither the hyperprolactinemia or vitamin D deficiency were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the contended conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral foot pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended prior cholecystectomy, hyperprolactinemia and vitamin D deficiency, the panel recommends no change from the PEB determinations 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 20170428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180016653, 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.