RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04105
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071030

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

CI CONTENTION:  “I was given a rating of 80% service connected disabilities from the VA effective the day after my discharge from the Army.”  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 - 20070905	VARD - 20080506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Heel Pain	5099-5003	0%	Plantar Calcaneal Spur, Left Foot	5010-5284	10%	20080205	
			Plantar Calcaneal Spur, Right Foot	5010-5284	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bilateral Heel Pain.  The PEB combined the left and right heel conditions under a single disability rating, analogously coded 5003, 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 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 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 separate rating if indicated. 

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral heel condition began in 2004 while deployed to Iraq.  The bilateral heel pain was aggravated by physical training, running, prolonged walking, walking on uneven ground and wearing combat boots.  During the 15 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported bilateral foot pain with walking, running and carrying weight.  Physical examination revealed bilateral heel tenderness and callouses.  Bilateral heel pain was elicited during the heel walk.  The 6 August 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported bilateral heel pain.  Physical examination showed good bilateral heel vascular status, no significant edema, no open lesions and normal neurologic examination.  Bilateral ankle range of motion (ROM) was “full” with painful motion.  Bilateral heel X-rays revealed bilateral heel spurs at the insertion of the Achilles’ tendon.  

At the 5 February 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported bilateral foot pain, stiffness and fatigability.  Flare-ups were reported as mild in severity and were precipitated by prolonged standing, walking, jumping and running.  Physical examination revealed a normal gait.  There were no bilateral foot, toe or flat foot deformities, but calcaneus (heel bone), plantar surface (sole of the foot) and Achilles’ tenderness was present.  The bilateral foot neurologic examination was normal.  Ankle ROM was not addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral heel condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left and right heel conditions 10% each, dual coded 5010-5284 (arthritis due to trauma-foot injuries, others), based on the C&P examination, citing functional loss due to pain.

The panel first considered if each foot condition remained separately unfitting, having been decoupled from the combined PEB adjudication.  In this case, the bilateral heel condition was permanently profiled and failed Army retention standards.  Panel members agreed that the functional limitations of each foot contributed to the CI’s inability to perform his military duties; and therefore, each foot was reasonably justified as separately unfitting.  Panel members agreed there was no limitation of foot or ankle motion, flat foot or other deformity in either lower extremity to support a 10% for either foot under VASRD §4.71a.  A 10% rating under code 5284 (foot injury, other) would require a “moderate” disability which the evidence did not support.  However, there was satisfactory evidence of painful ankle motion to support a 10% rating for each foot IAW VASRD §4.59, §4.40, and §4.45, as reported on the MEB NARSUM proximate to separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right heel condition and a disability rating of 10% for the left heel condition, both coded 5099-5003.

BOARD FINDINGS:  In the matter of the bilateral heel condition, the panel recommends that each heel be separately adjudicated as follows:  an unfitting right heel condition coded 5099-5003 and rated 10%, and an unfitting left heel condition, coded 5099-5003 and rated 10%, both 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	
Right Heel Pain	5099-5003	10%	
Left Heel Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

AR20190007255, 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.