RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04579
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “bilateral plantar fasciitis” 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 - 20080606	VARD - 20090217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	20%	Degenerative Posttraumatic Bilateral First Metatarsophalangeal Joints Changes with Mild Pes Planus	5099-5010	10%	20081203	
Bilateral Knee Pain	Not Unfitting	Bilateral Knee Pain	5261	NSC	20081203	
Low Back Pain	Not Unfitting	Low Back Condition	5237	NSC	20081203	
Bilateral Ankle Pain	Not Unfitting	Left Ankle Pain	5271	NSC	20081203	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral plantar fasciitis began in June 2006 with arch discomfort.  A podiatry clinic visit on 27 April 2007 showed decrease in the medial longitudinal arch height, bulging along the medial aspect of the talonavicular (TN) joint and calcaneal valgus with weight bearing bilaterally.  There was a full range of motion (ROM) of the STJs (subtalar joints) bilaterally.  Discomfort was elicited with palpation of the anterior talofibular ligament of the left foot with mild edema noted.  Weight bearing X-rays of the feet revealed a calcaneal inclination angle of 25 degrees and the medial uncovering of 1/3 of the talar head with no evidence of acute fracture.  The examiner’s assessment was congenital foot deformity-pes planus.   April 2007 X-rays of the feet showed mild pes planus, minimal bilateral first metatarsophalangeal joint degenerative changes and bilateral mild pes planus.  There was no evidence of effusion or other soft tissue abnormalities.  In September 2007, the podiatrist reported weight bearing X-rays of the feet were consistent with pes planus with a navicular cuneiform fault and more than 1/3 medial uncovering of the talar head with no evidence of acute fracture bilaterally.  The examiner assessed more than moderate pes planus with pronation on weight bearing.  As a result, the CI was unable to ambulate or stand in military shoe gear for prolonged periods. 

During the 26 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported that he was flatfooted and had fallen arches.  Physical examination revealed flat feet with pain across the anterior joint spaces.  There was also mild discomfort to the foot arches.  There was normal ROM, sensation and strength.  The CI was noted to have moderate, symptomatic pes planus.  

The 8 May 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of bilateral plantar fasciitis associated with symptomatic pes planus aggravated by prolonged standing or ambulation.  Physical examination showed a decrease in the medial longitudinal arch height, bulging along the medial aspect of the TN joint and calcaneal valgus with weight bearing bilaterally, which was more than moderate.  There was full ROM of the STJs bilaterally.  Discomfort was elicited with palpation of the anterior talofibular ligament of the left foot with mild edema noted.  Pulses were 2+/4 bilaterally; muscle strength was normal; light touch was grossly intact; and there were no skin lesions noted about the feet.

At the 3 December 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported he was pigeon-toed and had constant foot pain.  He used no custom shoes, inserts, braces or other ambulatory aids.    Physical examination showed bilateral plantar fasciitis from the insertion on the calcaneus to the mid plantar arch area.  He had mild to moderate pes planus.  Heels were 10 degrees valgus, reduced without any discomfort.  The Achilles tendons were intact.  There was no callus formation or other lesions of the feet, no deformity other than pes planus and no palpable tenderness other than the plantar fasciitis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 20% (10% for the right foot and 10% for the left foot), analogously coded 5399-5310 (muscle injury Group 10 muscles), citing “moderate muscle injury based on fatigue pain as a cardinal sign of muscle injury.”  The VA rated the bilateral foot condition 10%, analogously coded 5099-5010 (arthritis, due to trauma, substantiated by X-ray findings) based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints which may also be applied once to multiple joints if there is no limited or painful motion.

The panel noted the PEB rated each foot 10% using an analogous code for plantar fasciitis.   Since the CI also had pes planus, use of code 5299-5276 (flatfoot, acquired), would invoke pyramiding IAW VASRD §4.14.  However, were code 5276 to be used, the maximum rating based on moderate involvement for both feet would be 10% since it is assigned for bilateral or unilateral involvement.  Furthermore, based on subtle X-ray findings of the big toes, no more than a 10% rating using code 5099-5010 is warranted.  No other foot codes offered a higher rating than 10% for either foot.  After due deliberation, considering all of 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:  Bilateral Knee Pain Dysfunction, Low Back Pain and Bilateral Ankle Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or judged to fail retention standards; however, the commander’s statement noted the CI’s foot condition affected the knee and back conditions.

Bilateral Knee Pain.  The MEB NARSUM examination noted bilateral knee pain mostly on palpation of the patellae.  Both knees were stable, and no dysfunction was apparent on ambulation.  X-rays of the left knee in December 2008 showed no acute bony abnormality, a normal knee joint space and unremarkable soft tissues.  

Low Back Pain.  At a physical therapy visit in June 2007 there was tenderness of the lumbar spine but full ROM.  Straight leg raising (to determine nerve root irritation) was negative.  X-rays of the lumbar spine in June 2007 were negative.  At a physical therapy clinic visit in September 2007, the thoracolumbar spine exhibited abnormal lordosis and was tender to light palpation over large areas of the thoracolumbar region.  Although there was pain and limited flexion during ROM testing, the CI had full lumbar flexion without complaint of pain or expression of pain when putting on his shoes.  The NARSUM examination demonstrated normal ROMs, good upper body strength and the CI did not appear to have any significant back problems.

Bilateral Ankle Pain.  X-rays in April 2007 of the bilateral ankles were unremarkable.  Examination of the ankles in June 2007 showed normal appearance and full ROM without painful motion.  There was no laxity and a talar tilt test was negative, but there was severe tenderness of the lateral aspect of the left ankle and weakness with severe pain.  A physical therapy ROM study in September 2007 showed dorsiflexion of the left ankle of 0 degrees (normal 20) and plantar flexion 30 degrees (normal 45), but the CI was observed removing his left ankle brace forcefully without expression of pain and moving his left ankle through a full ROM without limitation or pain response.  Although the posterior talofibular ligament was tender, there was no tenderness with distraction.  Strength of the left ankle was normal with pain on resisted movement.  A left-sided antalgic gait was observed with a shortened stride bilaterally and a minimal limp.  The CI received an AFO brace in October 2007, and at the NARSUM examination the CI’s left ankle was noted to feel better with the brace.  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 bilateral foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee, low back, and bilateral ankle 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.	

[AR Number],XXXXXXXXXX. 

Dear XXXXXXXXXX:

	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. 

A copy of this decision has been provided to the counsel you listed on your application