RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04839
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Radio And Communications Security Repairer, medically separated for “moderate plantar fasciitis, bilateral, left greater than right, and left foot pain secondary to Morton’s neuroma” with a disability rating of 20%.  

CI CONTENTION:  Review requested of foot conditions as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090415	VARD - 20090917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Plantar Fasciitis, Bilateral… 	5299-5284	20%	Plantar Fasciitis, Left 	5020-5271	20%	20090812	
			Plantar Fasciitis of the Right Foot	5020-5271	20%	20090812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Moderate Bilateral Plantar Fasciitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with plantar fasciitis of the right foot on 9 January 2007 and was given a temporary profile.  He was treated with a nonsteroidal anti-inflammatory drug and advised to use ice and perform stretching exercises.  The pain improved but recurred with resumption of full activity.  On 19 July 2007, he was diagnosed with bilateral plantar fasciitis and orthotics were ordered.  Weight bearing foot X-rays on 14 September 2007 showed a bilateral pes planus deformity, right greater than left, and a minimal right-sided soft tissue bunion deformity.  At a podiatry visit on 18 September 2007, the bilateral plantar fasciitis diagnosis was confirmed and the CI subsequently received cortisone injections in the left foot on 11 October 2007, and then in each foot on 31 October 2007.  About a month later, he was given a left foot arch wrap.  Despite treatment, the foot pain interfered with duty performance.  

On 6 March 2008, the CI underwent extra corporeal shock wave therapy with some improvement, but continued mild residual pain.  He then had an instep release procedure (plantar fasciotomy) on his left foot on 6 May 2008, but reported pain after returning to duty, despite postoperative care and rehabilitation.  A hypertrophic surgical scar from the left foot surgery site bothered him, especially when running.  In July 2008, he was restarted on conservative care, which included orthotics.  At a 28 January 2009 podiatry appointment, he described moderate to severe sharp shooting, “electric shock” pain and tingling in the area of the left foot surgery despite several treatment modalities.  On examination, there was tenderness of the calcaneal tuberosity and a hypertrophic scar.  New imaging studies were inconclusive.  

During the 11 February 2009 MEB NARSUM examination, 6 months prior to separation, the CI complained of plantar fasciitis, and the examiner noted moderate pes planus bilaterally without any swelling or erythema.  There was a well-healed hypertrophic scar overlying the instep of the left foot and mild tenderness over the medial plantar aspect of the foot.  Bilateral foot and ankle X-rays on 5 August 2009 were normal.

At the 12 August 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported bilateral heel pain since November 2006.  Physical examination showed normal foot pulses and capillary filling time.  Neurologic evaluation was unremarkable and he could move his first toes without any pain.  Right ankle range of motion (ROM) measurements showed dorsiflexion to 1 degree (normal 20) and plantar flexion to 22 degrees (normal 45).  Left ankle dorsiflexion was to 3 degrees and plantar flexion to 25 degrees.  There was no pain during motion or with palpation of both heels.  The CI had an antalgic gait with arches slightly decreased upon weight bearing.  The Achilles tendons were rectus (straight) and did not hurt on manipulation, and he was able to toe raise on both feet.   The examiner’s diagnosis was chronic plantar fasciitis, which was likely due to a preexisting condition that was exacerbated by military service and continued to cause pain and inflammation at the heels.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis 20%, analogously coded as 5284 (other foot injuries), citing 10% for each foot for moderate bilateral foot impairments.  The VA rated the plantar fasciitis 20% for each foot, dual coded 5020-5271 (synovitis-limited motion of ankle), based on the C&P examination, citing marked limited motion of each ankle.  Panel members noted that the PEB assigned a 10% using code 5284 for a moderate disability although there was no report of any foot injury prior to the left foot instep release procedure.  Additionally, the MEB referred “chronic left foot pain, secondary to Morton’s neuroma” to the PEB although there was no evidence of a Morton’s neuroma.  The VA used code 5020-5271 for marked limitation of each ankle, but there was no injury or surgery to either ankle or to the muscles of the leg involved in dorsiflexion and/or plantar flexion of the ankle to explain the limitation of motion of either ankle.  To use an ankle code for either foot disability is inconsistent with the unfitting conditions, since the etiology of the bilateral ankle motion limitations is not in the scope of review.  Thus the panel considered the more appropriate plantar fasciitis coding under 5399-5310 (Group X. Function:  movements of forefoot and toes; propulsion thrust in walking.) IAW VASRD §4.73 (muscle injuries), noting that a moderate disability warrants a 10% rating, while a moderately severe disability warrants a 20% rating.  Of the multiple examinations prior to separation and at the VA examination, the CI was only moderately symptomatic, even though he did report more pain after running or marching.   Panel members determined that even if the plantar fasciitis and left foot scar were considered together, the disability did not rise to a moderately severe foot injury, and separate ratings for plantar fasciitis and a scar, which is not in the scope of review, would be inconsistent with VASRD §4.14 (avoidance of pyramiding).  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 plantar fasciitis and IAW VASRD §4.71a, 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:  

PD-2017-04839

[AR NUMBER], XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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

				PD-2017-04839