RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05181
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Tracked Vehicle Mechanic, medically separated for “type II diabetes mellitus” and “right plantar fasciitis,” rated 20% and 0%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  Review requested of the diabetes and 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 - 20051013	VARD - 20070525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type II Diabetes Mellitus	7913	20%	Type II Diabetes Mellitus	7913	20%	20070201	
Right Plantar Fasciitis	5399-5310	0%	Plantar Fasciitis with Heel Spur, Right Foot	5299-5284	10%	20070131	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Type II Diabetes Mellitus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with diabetes in June 2005 when he was noted to have an elevated blood sugar.  His hemoglobin A1C at the time of diagnosis was 7.6, and his condition was treated with oral hypoglycemic medication.  

The 6 September 2005 MEB NARSUM examination, 3 months prior to separation, noted the CI could not perform in his military specialty due to the requirement for diabetes medication.  Excluding the musculoskeletal system, the general physical examination (PE) was normal.  

The 1 February 2007 VA Compensation and Pension (C&P) examination, 14 months after separation, noted the CI continued to take oral medication for his diabetes, and denied specific physical complaints with regard to his condition.  The PE remained normal.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the diabetes mellitus 20%, using VASRD code 7913 (diabetes mellitus), citing oral medication use and restricted diet.  Panel members agreed that the requirement for oral hypoglycemic treatment and restricted diet justified a 20% rating.  Because there was no evidence of medically prescribed regulation of activities, the next higher 40% rating was not justified.  Furthermore, following initiation of treatment at the time of diagnosis, the STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalizations or frequent visits to a diabetic care provider (twice a month or more frequently), or complications that could support a higher rating.  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’s adjudication for the diabetes mellitus.  

Right Plantar Fasciitis.  According to the STR and MEB NARSUM, the CI’s right heel became painful after completing a running exercise as part of a physical training program in January 2005.  An X-ray revealed a small heel spur and a bone scan was consistent with right plantar fasciitis.  Despite physical therapy, local injections, and a soft shoe profile, the CI’s foot pain remained.  

The 25 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, noted “mild symptomatic pes planus (flat feet).”  The 6 September 2005 MEB NARSUM examination, 3 months before separation, noted continued complaints of right heel pain.  The PE revealed a slightly antalgic gait, and range of motion of the right ankle was decreased and painful.  Ankle plantar flexion was to 25 degrees (normal 45) and dorsiflexion was normal.  The foot/heel pain was assessed as “…slight and constant to moderate and occasional.”  

At the 31 January 2007 VA C&P examination, 14 months after separation, the CI endorsed right foot pain aggravated by prolonged standing and upon taking the first steps in the morning.  The PE revealed tenderness on the bottom aspect of the right heel and along the plantar fascia.   The examiner noted a “neutral” gait and that the arch was maintained with “no evidence of flat feet.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right plantar fasciitis 0%, analogously coded 5310 (muscle group X impairment), citing a slight level of impairment.  The VA rated the plantar fasciitis 10%, analogously coded 5284 (foot injuries; other), citing pain in the right plantar fascia and heel.  Panel members first agreed that the totality of examination probative value be apportioned to the pre-separation encounters due to their close time reference to separation versus the 14 month remote VA examination.  Members then considered possible rating schemes of either painful motion (VASRD §4.59), limited ankle motion, or group X muscle code, and concluded that each pathway would support no greater than a 10% rating, citing painful motion, moderate limited motion, or moderate muscle injury, respectively.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel agreed with the PEB’s coding scheme and recommends a disability rating of 10% for the right plantar fasciitis.  

BOARD FINDINGS:  In the matter of the diabetes mellitus and IAW VASRD §4.120, the panel majority recommends no change in the PEB adjudication.  In the matter of the right plantar fasciitis, the panel recommends a disability rating of 10%, analogously coded 5310 IAW VASRD §4.73.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Diabetes Mellitus	7913	20%	
Right Plantar Fasciitis	5399-5310	10%	
COMBINED	30%	

XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.