RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05318
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Administrative Specialist, medically separated for “bilateral plantar fasciitis with bilateral pes planus” with a disability rating of 0%.   

CI CONTENTION:  The condition continues to worsen and negatively impact daily activities and quality of life.  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 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 - 20050914	VARD - 20060201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis with Bilateral Pes Planus	5399-5310	0%	Bilateral Plantar Fasciitis with Mild Hallux Valgus and Bunion at the First MP Joint And Pes Plano-valgus	5280-5276	10%	20051013	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis with Bilateral Pes Planus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral plantar fasciitis was first diagnosed in February 2004 without a prior history of trauma or inciting event.  Despite physical therapy, orthotics, medications, and restrictive activity, the painful symptoms continued.     

The 23 August 2005 MEB NARSUM examination, 4 months prior to separation, noted the CI’s chief complaint as ‘bilateral foot pains at the heels’.  The physical examination (PE) revealed tenderness along the inside and bottom aspects both feet with bilateral painful motion.  At the 13 October 2005 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported bilateral foot pain (about the heel area) while standing and walking.  Her PE revealed a normal gait and she did not require any assistive device for ambulation.  Neither foot showed any signs of abnormal weight-bearing.  Both feet revealed painful motion and ‘slight’ tenderness about the underside of the foot.  The provider additionally noted, “[The CI] does not have any limitation with standing and walking.”    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis with bilateral pes planus condition 0%, analogously coded as 5310 (Group X. Function: movements of forefoot and toes), citing parameters of ankle range of motion as well as ‘slight’ pain.  The VA rated the same condition as well as mild hallux valgus and bunions at 10%, dual coded 5280-5276 (unilateral hallux valgus - acquired flatfoot), based on the STR and  C&P examination, citing painful motion and tenderness to both feet.

The panel’s initial charge in this case was directed at determining if the PEB’s approach of combining the two conditions and the bilateral nature of each separate condition under a single rating was justified in lieu of overall separate ratings.  All panel members agreed that it would be purely speculative to conclude that the disability confined separately to either foot would have rendered the CI incapable of performing within her occupational rating.  Additionally, members found it reasonable to surmise that it was the combination of pathology from both feet that rendered the CI unfit to perform her military duties.  

After extensive deliberation, the panel concluded that the bilateral diagnosis of pes planus (which often is a precursor to plantar fasciitis) was properly captured and was thus subsumed under the PEB coding of the primary condition.  Additionally, members agreed that the minimal adverse PE findings coupled maintaining a normal gate near the time of separation along with the provider’s comment of having no limitations with standing and walking, would not support a positive impairment rating.  Pursuant to this rationale coupled with the consideration of the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed that a disability rating of 0% for the bilateral foot condition was appropriately recommended in this case.  Therefore, members concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral plantar fasciitis with bilateral pes planus condition.  

PD-2017-05318

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXX

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.

Sincerely,					      

Enclosure

PD-2017-05318