RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03292
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “right plantar fasciitis” and “left plantar fasciitis,” rated 10% each, with a combined 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 - 20090826	VARD - 20090812	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Plantar Fasciitis	5299-5276	10%	Bilateral Pes Planus with Plantar Fasciitis	5276	30%	20090423	
Left Plantar Fasciitis	5299-5276	10%					
Right Pes Planus	Not Unfitting					
Left Pes Planus	Not Unfitting					
Overactive Bladder	Not Unfitting	Overactive Bladder	7599-7542	40%	20090423	
Costochondritis	Not Unfitting	Costochondritis	5399-5321	0%	20090423	
Right Shin Splint	Not Unfitting	Right Shin Splint	5399-5312	0%	20090423	
Left Shin Splint	Not Unfitting	Left Shin Splint	5399-5312	0%	20090423	
Lumbar DDD	Not Unfitting	Lumbar DDD	5242	10%	20090423	
Right Ankle Tendinopathy	Not Unfitting	Right Ankle Tendinopathy	5271	10%	20090423	
Left Ankle Tendinopathy	Not Unfitting	Left Ankle Tendinopathy	5271	10%	20090423	
Pseudofolliculitis Barbae	Not Unfitting	Pseudofolliculitis Barbae	7813-7806	10%	20090423	
PTSD	Not Unfitting	PTSD	9411	30%	20090501	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Right and Left Plantar Fasciitis   According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral foot pain began in 2008 during his third deployment due to constant climbing, driving, and standing for extended periods of time.  Bilateral plantar fasciitis and pes planus were diagnosed.  He was given a permanent L3 profile for these conditions.  X-rays showed bilateral pes planus.  The July 2002 MEPS Report of Medical Examination (DD Form 2808) noted mild-asymptomatic pes planus at time of service entry.  

A podiatry examination on 9 February 2009, 10 months before separation, revealed complaints of bilateral foot pain which was worse at night after being on his feet all day.  Physical examination showed “feet abnormalities” which were not specified.  Later the examiner stated “feet showed a normal appearance.”  There was bilateral foot tenderness, and tenderness of the plantar and medial plantar aspects of the heel.  A plantar fasciitis test elicited pain.  Bilateral foot motion was normal and did not elicit pain.  The CI was diagnosed with bilateral plantar fasciitis and hip pain, issued a temporary profile for no running, and prescribed custom shoe inserts for bilateral “over pronation, flat feet (pes planus) and plantar fasciitis.”  

At the 23 April 2009 VA Compensation and Pension (C&P) General examination, 7 months before separation, the CI reported constant pain in the heel and down the middle of the feet.  Pain was elicited by physical activity and excessive walking or standing, and was relieved by stretching, medication, ice, and rest.  The CI could function with medication.  He was never hospitalized nor had surgery.  Physical examination showed a normal gait and posture.  There were bilateral flat feet.  Bilateral palpation of the plantar surfaces revealed slight tenderness.  There was no bilateral painful motion, edema, disturbed circulation, weakness, atrophy of the musculature, heat, redness, or instability.  There was no abnormal weight bearing or breakdown, callosities, or any unusual shoe wear pattern.  He did not require shoe supports or any assistive device for ambulation.  The CI had no limitations with standing or walking.  Alignment of the bilateral Achilles tendon was normal.  Bilateral pes planus was present.  Moderate bilateral forefoot/midfoot valgus was present (foot angled outward with some weight placed on fibula) which could not be corrected by manipulation, and there was marked pronation deformity.  

The 10 June 2009 MEB NARSUM examination, 6 months prior to separation, was performed by the aforementioned VA examination as part of the pilot Integrated Disability Evaluation System (IDES).  In addition to the VA examination’s findings, the MEB NARSUM documented the CI was given a soft shoe profile and inserts, but still had bilateral foot pain, implying the CI was not able to use his military boots.  His foot conditions were stable at the time.  A bilateral pes planus diagnosis was rendered that did not meet retention standards, existed prior to service, but was service aggravated.  

The panel directed attention to its rating recommendation based on the above evidence.  Using the VA’s IDES rating recommendation, the PEB rated the right and left plantar fasciitis conditions 10% each, using the analogous code 5299-5276 (flatfoot, acquired (pes planus)), citing limited ability to load bear, stand for long periods, and run secondary to pes planus.  [The panel majority noted that 5276 criterion does not allow a 10% rating for each foot.  Only one 10% rating can be applied to either a unilateral or bilateral condition.  It appeared the VA issued a bilateral 10% rating and the PEB may have misinterpreted this and applied 10% to each foot.]  The VA combined the right and left plantar fasciitis with the bilateral pes planus and provided a 30% rating, coded 5276, based on the C&P examination, taking into account all of the CI’s symptoms of marked deformity, pain on manipulation and use, and tenderness of the plantar surface.  The panel considered and debated at length the meaning of the VASRD 5276 coding in the context of the CI’s condition and disability rating.  

Based on the VA examination, most comprehensive and proximate to separation, the panel found each of the CI’s plantar fasciitis conditions was “moderate” to support a 10% for each foot under code 5310 (group X (plantar fasciitis).  Based on VASRD §4.3 (higher of two evaluations), the panel majority also considered the CI’s rating under 5276 (pes planus).  The VA examination revealed “marked” bilateral pronation deformity.  Bilateral palpation of the plantar surfaces revealed slight tenderness, but no pain on manipulation, no swelling with use, and no callosities.  Gait and posture were normal and he had no limitation with standing and walking.  He was diagnosed with plantar fasciitis which was aggravated by running and playing football and basketball.  His condition was considered stable and the bilateral fasciitis was attributed to his pes planus condition.  The panel therefore could not support a bilateral 30% rating based on this evidence.  The panel also considered code 5278 (claw foot), severe hallux valgus (5280), hammer toe (5282), fractures with malunion or nonunion (5283), and injuries to either foot (5284), but the VA and STR evidence did not meet criteria for a higher rating under those codes.  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 right and left plantar fasciitis condition. 

Contended PEB Conditions:  Right and Left Pes Planus, Overactive Bladder, Costochondritis, Right and Left Shin Splints, Lumbar DDD (Degenerative Disc Disease), Right and Left Ankle Tendinopathy, Pseudofolliculitis Barbae, and PTSD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  

Pes Planus:  The panel first considered if the bilateral pes planus was separately unfitting from the bilateral plantar fasciitis condition.  During a combat aviation clinic visit in March 2008, physical examination revealed bilateral pes planus.  The CI’s “flat feet” were also identified by a podiatrist in February 2009, 10 months before separation.  The CI was issued shoe inserts for bilateral “over pronation, flat feet and plantar fasciitis.”  The CI was subsequently given a permanent L3 profile for bilateral plantar fasciitis and pes planus in March 2009; 8 months prior to separation.  The commander’s statement, also 8 months prior to separation, did not implicate a medical condition but referenced the permanent L3 profile restrictions:  the CI cannot wear combat gear [move with a fighting load at least 2 miles], run, walk, or stand for more than 20 minutes; nor lift more than 40 pounds.  The MEB NARSUM diagnosed right and left pes planus which did not meet retention standards, EPTS, and service aggravated.  However, the panel noted that the CI did not seek medical attention for bilateral foot pain until February 2008, while deployed to Iraq, close to 6 years after entering active duty.

The contended overactive bladder, costochondritis, right and left shin splint, lumbar DDD (degenerative disc disease), right and left ankle tendinopathy, pseudofolliculitis barbae, and PTSD conditions were not profiled, implicated in the commander’s statement, or judged to fail retention standards.  Although the MEB NARSUM documented an S3 profile for PTSD, this profile was not found in evidence.  The CI’s final profile showed a permanent S1 (considered to possess a high level of medical fitness).  A mental health condition was not implicated by the commander’s statement or judged to fail retention.

The panel agreed there was no performance-based evidence from the record that any of the 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 right and left plantar fasciitis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right and left pes planus, overactive bladder, costochondritis, right and left shin splints, lumbar DDD, right and left ankle tendinopathy, pseudofolliculitis barbae, and PTSD conditions, 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 20170330, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180012281, 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.

Sincerely,					      

Enclosure