RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04659
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Abrams Tank Mechanic, medically separated for “bilateral foot pain from plantar fasciitis and pes planus” with a disability rating of 20%.   

CI CONTENTION:  The condition continues to worsen.  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 – 20081105	VARD - 20090406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain from Plantar Fasciitis and Pes Planus	5399- 5310	20%	Bilateral Pes Planus	5276	0%	20081117	
			Bilateral Plantar Fasciitis	5299-5276	NSC	20081117	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Bilateral Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot began gradually toward the end of 2006, and he was treated with over-the-counter medications, custom orthotics, steroids and physical therapy without significant improvement.  There was no surgical indication.  

The 30 September 2008 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of constant bilateral foot pain mostly in the heels and arches that was sharp and worsened with the first few steps in the morning.   He was able to walk, but not run, and had passed previous two fitness tests with the alternative walk test.  He took only one an oral anti-inflammatory medication once or twice a week for pain.  Physical examination demonstrated a moderate degree of pes planus bilaterally on weight bearing, but a normal gait.  There was mild plantar fascia tenderness over the arches and at the insertion into the heels.  

At the 17 November 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported pain in the medial arches and heels bilaterally.  Pain increased with running and extended walking, but had no effect on daily activities or work.   Physical examination demonstrated a normal gait.  There was moderate pes planus of both feet without tenderness or signs of abnormal weight bearing, and the Achilles tendon was normally aligned.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot pain 10% for each side, analogously coded 5399-5310 (muscle injuries, Group X), citing tenderness of the plantar fascia, normal gait, and pain on repeated use with VASRD §4.56 criteria met for  moderate muscle disability with one cardinal sign (fatigue-pain).  The VA rated the bilateral pes planus 0%, coded 5276 (acquired flat foot), based on the C&P examination, citing no evidence of any abnormality of the Achilles tendon, weight-bearing line over the great toe or pain on manipulation.  Members agreed there was no evidence of claw foot (5278), hammer toe (5282) or severe hallux valgus (5280) in either foot to justify a rating under those respective codes.  Additionally, there were no fractures with nonunion (5283) in either foot, and no evidence of metatarsalgia (5279), or acquired flat foot (5276) with pain on manipulation or use of either foot to substantiate a 10% rating.  The panel agreed, with no gait abnormalities, the degree of disability  characterized by Group X muscle injuries, which includes the plantar aponeurosis (plantar fascia), was slight, or at most moderate bilaterally, for a 10% rating for each foot as adjudicated by the PEB.  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 bilateral foot condition.  

BOARD FINDINGS:  In the matter of the bilateral foot pain and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  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:

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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.

Enclosure