RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic bilateral foot pain” with a disability rating of 0%.

CI CONTENTION:  Other conditions were not evaluated.  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 - 20060825	VARD - 20070228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Foot Pain	5399-5310	0%	Right Foot, Plantar Fasciitis 	5299-5284	10%	20061006	
Bilateral Asymptomatic Hallux Abductovalgus	Not Unfitting	Left Foot, Plantar Fasciitis 	5299-5284	10%	20061006	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to the service treatment record (STR) and MEB NARSUM, the CI’s foot pain began in November 2003 after performing a fireman’s carry, and he was then treated for right foot plantar fasciitis in February 2004.  A sports medicine evaluation in September 2005 documented bilateral pes planus and assessed right heel pain “likely due to combination of initial fat pad syndrome with plantar fasciitis secondary to gait changes from initial injury.”

During the 11 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported foot problems.  Physical examination revealed tenderness around the right foot plantar fascial insertion and no joint instability.  Bilateral foot and ankle range of motion (ROM) was “full,” but painful motion not addressed.  The 21 June 2006 MEB narrative summary (NARSUM) examination noted CI complaints of chronic bilateral foot pain.  He had heel pain that was worse with the first steps out of bed in the morning, and he was unable to carry heavy equipment or do any running, marching, or rucking without severe pain (right greater than left).  Focused lower extremity examination showed flexible pes planus (during weight bearing), hallux valgus bilaterally, right greater than left heel tenderness, and no evidence of inflammation in either foot or ankle.  Neurovascular findings and muscle strength were normal, and bilateral subtalar and ankle joint ROM was “within normal limits” without pain or crepitus.  

At the 6 October 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain in both feet that traveled from the heel to the ball of each foot and was increased with any standing or walking.  Physical examination showed bilateral foot tenderness but a normal gait and no evidence of edema.  Dorsiflexion was 20 degrees (normal) and plantar flexion was 45 degrees (normal) bilaterally with pain in each foot during ROM testing.

The panel first noted that although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows ratings for separately compensable joints.  In accordance with DoDI 6040.44 the panel must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each “unbundled” condition can be reasonably justified as separately unfitting in order to remain eligible for Service rating.  If panel members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The panel reviewed the commander’s statement, written 6 months before separation, which documented that the CI was unable to perform the duties of an infantryman due to his condition and profile, and that his limitations had an adverse impact on the unit’s mission.  Members agreed that both the left and right foot conditions were reasonably considered separately unfitting.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, analogously coded 5399-5310 (Group X, movements of forefoot and toes, citing mild symptoms.  The VA rated each foot condition 10%, analogously coded 5299-5284 (foot injuries, other), based on the C&P examination, citing moderate symptoms.  Members noted that the right foot was problematic to the extent that every clinic visit reflected complaints of right foot pain.  The STR demonstrated that from April 2004 to April 2006, the CI was treated for plantar fasciitis of the right foot.  The panel agreed that the preponderance of evidence supports a 10% rating under code 5399-5310 for moderate impairment.  Members agreed that the record sufficiently documented left foot tenderness, but the preponderance of evidence did not support a rating higher than 0% under code 5310.  However, a 10% rating for the left foot was justified for painful motion with functional loss IAW VASRD §4.59 and §4.40 (painful motion and functional loss), coded 5099-5003, as recorded in the C&P examination.  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 right foot condition coded 5399-5310, and  10% for the left foot condition, coded 5099-5003,

Contended PEB Condition:  Bilateral Asymptomatic Hallux Abductovalgus.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  
BOARD FINDINGS:  In the matter of the bilateral foot pain condition, the panel recommends a disability rating of 10% for the right foot condition coded 5399-5310 IAW VASRD §4.73; and a 10% for the left foot condition coded 5099-5003 IAW VASRD §4.71a.  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 Right Foot Pain	5399-5310	10%	
Chronic Left Foot Pain	5099-5003	                10%	
COMBINED	 20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009788, 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