RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02937
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E8, Administrative Specialist, medically separated for “bilateral plantar fasciitis” with a disability rating of 0%.  

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 - 20061017	VARD - 20080701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	No VA Examination Proximate to Separation	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis (PF).  The PEB combined the right and left PF under a single disability rating, coded analogously to 5310 (Group X muscle injury) and rated 0%.  This 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.  The panel’s initial charge in this case was therefore directed at determining if 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 PF is presented below, with attendant recommendations regarding separate unfitness, and separate rating if indicated. 

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of bilateral pes planus (flat feet) and bunion surgeries (April 2005), and began to experience pain in both feet soon after a second right foot bunionectomy in December 2005.  She was diagnosed with PF which remained persistent despite treatment with medications, splinting and orthotics.  Foot X-rays on 16 May 2006 showed post-surgical changes of both feet with screws present in both first metatarsals and no other abnormalities noted.  

The commander’s statement dated 2 August 2006 implicated both foot conditions as impairing the CI’s successful duty performance, and the permanent profile on 20 September 2006 listed chronic bilateral PF.  During the 28 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported bilateral foot pain, especially in the morning and after prolonged walking, and that she used orthotics.  Physical examination showed moderate pes planus, hallux valgus, and surgical scars of both feet.  At a family practice clinic visit on 8 September 2006, the CI reported continued foot pain and stiffness despite treatment.  On physical examination, there was tenderness along the bottom of both feet, but foot motion was normal with no pain elicited during movement.  

The 16 September 2006 MEB NARSUM examination, 2 months before separation, noted complaints of bilateral foot pain.  The CI reported that she could wear boots with insoles, but could not run or walk for prolonged periods.  Pain was usually worse in the morning or after getting up from a seated position.  Physical examination showed a slightly antalgic gait, but the ability to heel and toe walk.  Surgical scars were well-healed, and there was tenderness in the heel area on the left foot, and in the heel area and under the base of the great toe on the right foot.  The examiner determined the CI fell below retention standards due to bilateral PF.  There was no VA examination in evidence proximate to separation.

The panel first considered whether the right and left foot conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Both feet were profiled, implicated in the commander’s statement, and failed retention standards.  The STR documented visits for bilateral foot pain and PF treatment, thus panel members concluded there was not a preponderance of evidence in the service records which overcame the presumption that each of the conditions was reasonably considered separately unfitting.  

The panel then considered its rating recommendation for the unfitting PF conditions at the time of separation.  As noted above, the PEB rated the bilateral PF 0%, analogously coded 5399-5310.  Panel members noted that the objective findings and associated disability for the right and left PF conditions were identical, and agreed the respective ratings should therefore be the same.  A 10% rating was supported for each foot for “moderate” muscle injury, coded 5399-5310 IAW VASRD §4.73 (muscle injuries), based on the MEB NARSUM examination and the majority of treatment notes documenting tenderness of the bottom of both feet, without swelling, callosities, or marked deformity.  The panel also considered a rating coded analogous to 5276 (flat foot, acquired), since the CI was noted to pes planus along with PF, which is often associated.  A 10% rating was supported for moderate flat foot deformity (whether unilateral or bilateral), based on pain on use of the feet but without marked deformity, swelling or characteristic callosities on the bottom of the feet.  However, this provided no benefit to the CI.  The panel also considered rating for bilateral hallux valgus (5380) with resection of the metatarsal heads, however, the main foot complaint was pain on the bottom of both heels, consistent with PF, which was best characterized by code 5310.  The panel considered other VASRD foot codes, but all were less applicable and/or not advantageous for rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% each for the right and left foot conditions, both coded 5399-5310.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis, the panel recommends that each joint be separately adjudicated as follows: unfitting right foot plantar fasciitis coded 5399-5310 and rated 10%; and unfitting left foot plantar fasciitis, coded 5399-5310 and rated 10%, both 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	
Right Plantar Fasciitis 	5399-5310	10%	
Left Plantar Fasciitis	5399-5310	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190010004, 

Dear XXXXXXXXXXXXXXXX:

	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.