RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05244
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O3, Combat Engineer, medically separated for “chronic plantar fasciitis bilateral feet” with a disability rating of 0%.   

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 - 20050818	VARD - 20060616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Plantar Fasciitis Bilateral Feet	5399-5310	0%	Bilateral Plantar Fasciitis	5299-5276	10%	20060516	
Mild Persistent Asthma	Not Unfitting	Asthma	6602	10%	20060516	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Plantar Fasciitis Bilateral Feet.  The PEB combined the right and left plantar fasciitis conditions under a single disability rating, coded 5310-5399 (analogous to Group X muscle injuries) 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’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.  

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral plantar fasciitis began in October 2003 without a history of trauma.  The CI underwent three steroid injections in the left heel, had bilateral custom orthotics and was also treated with physical therapy.  He was offered surgery and another non-invasive procedure for the left heel, but made an informed decision not to undergo either, which was noted to be reasonable.  

During the 13 April 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported wearing night splints and custom orthotics and was performing stretches.  Physical examination recorded normal feet.  The 28 April 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of pain in the heels, left greater than right, and an inability to wear the ballistic helmet.  There was no physical examination of the feet reported.  

At the 7 March 2006 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported difficulty with both feet with standing and walking for protracted periods of time on hard concrete floors.  Physical examination showed the CI was not wearing shoe orthotics or other adaptive equipment.  His gait was normal.  

A VA orthopedics C&P examination on the same day noted complaints of both sharp and dull pain along the medial instep, worse with standing for protracted periods of time and walking long distances.  Examination showed normal heel-toe gait and inspection of the shoes did not reveal abnormal wear patterns.  There was mild tenderness along the medial instep of the right foot with full range of motion (ROM) of the subtalar joint without painful motion.  The left foot showed a flat foot with weight bearing.  There was mild tenderness on the medial instep, predominantly at the base of the heel.  There was normal subtalar ROM.  No callouses were noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis 0%, coded analogously to 5310 (Group X. Function: movements of forefoot and toes), citing mild pain.  The VA rated the bilateral plantar fasciitis 10%, coded analogously to 5276 (flatfoot, acquired), based on the C&P examination 5 months after separation, citing the weight-bearing line was over or medial to the great toe with inward bowing of the tendo Achilles and pain on manipulation and use of the feet.  

The panel first considered if the right and left plantar fasciitis, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, both feet were considered to fail retention standards by the PEB and were implicated by the NARSUM, the profile and the commander’s statement.  Review of the STR evidence shows that the majority of the visits were for bilateral foot pain, though the right had improved with therapy.  Since undue speculation would be required to conclude that impairment from either would not have unacceptably interfered with MOS performance, members agreed that each foot was reasonably justified as separately unfitting.  

The panel next addressed ratings for each unfitting foot.  There was no evidence of acquired flat foot (5276), claw foot (5278), or severe hallux valgus (5280) in either foot to justify a rating under the respective codes.  There was no evidence of hammer toe (5282), fractures with malunion or nonunion (5283) or injuries to either foot that would be characterized as moderate (5284) to validate ratings under those codes.  There was no evidence of metatarsalgia to substantiate a 10% rating using code 5279 which specifies unilateral or bilateral.  Panel members agreed that the degree of disability displayed in the bilateral foot condition was best characterized as slight under code 5310 in each foot as was adjudicated by the PEB.  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 plantar fasciitis.  

Contended PEB Condition:  Asthma.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Though the MEB felt the contended condition did not meet retention standards, the PEB overturned that determination.  Pulmonary function tests were normal.  The commander, in his statement, mentioned that the CI was diagnosed with, and had to deal with asthma, but did not indicate that the asthma caused any duty limitations.  The PEB noted that the 6 April 2005 profile (and all previous profiles) addressed only the plantar fasciitis.  The first profile that listed asthma was written on 27 July 2005, the day the MEB was convened, and there were no additional restrictions listed on the profile compared with previous profiles that could be attributed to the asthma condition.  The functional limitations and capabilities and other comments listed in block 10 of this new profile were identical to the previous profile that listed bilateral plantar fasciitis only.  In the asthma addendum, the examiner stated the CI was unable to exercise due to his orthopedic problem but full assessment of exercise tolerance and ability to pass the APFT, wear a protective mask with exercise and maintain worldwide deployability status due to the asthma condition could not be adequately assessed.  Therefore, the panel determined that it would be speculative to attribute any of the above limitations to the asthma condition.  

The PEB declared the asthma condition not separately unfitting, saying that there were minimal entries in the health record and no profile for asthma until after the MEB was done.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended asthma condition, the panel recommends no change from the PEB determination 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170613, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007377, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure