RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05543
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “bilateral foot pain secondary to plantar fasciitis without foot deformity” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 - 20060126	VARD - 20061023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Foot Pain… 	5399-5310	0%	Bilateral Plantar Fasciitis and Pes Planus	5276	0%	20060419	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  The PEB combined the left and right foot pain conditions under a single disability rating, analogously coded 5399-5310 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.  
Bilateral Foot Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral foot condition began in 2003, with no history of trauma and pain occurring mainly over the medial navicular bones and plantar fasciae.  An MRI, bone scans, and nerve conduction studies all were essentially unremarkable and she was referred to a foot and ankle specialist.  Other than treatment for chronic plantar fasciitis, no additional intervention was recommended.  The 22 December 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of bilateral foot pain.  The CI reported occasional swelling of the feet and the inability to run.  She could stand for only 15-30 minutes before the pain required getting off her feet, but she could walk for 3-4 miles without a load.  Physical examination of both feet showed no edema or effusion, and full ankle and toe range of motion (ROM).  Bilaterally, there was some tenderness over the medial navicular and surrounding soft tissues of each foot, minimal tenderness over the plantar calcaneus, and moderate tenderness over the Achilles insertion.  During the 18 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month before separation, the CI reported bilateral foot pain, plantar fasciitis, and bunions.  Physical examination revealed pain with dorsiflexion of the feet.

At the 19 April 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued bilateral foot pain.  She state that she had been provided 3 different types of shoe inserts, including arch supports which she used daily; however she did not have them the day of the examination.  She took a non-steroidal anti-inflammatory drug for pain, and denied stiffness or swelling.  The CI was not working and was 4 months pregnant.  Physical examination of both feet revealed 15 degrees of hallux valgus with no tenderness over the first metatarsophalangeal joints.  Repetitive ankle and toe ROM was normal with no painful motion or degradation from pain, fatigue, weakness, lack of endurance or incoordination.  Tenderness was present during deep palpation in the plantar fascial areas bilaterally, but there were no functional limitations on standing and walking.

The PEB rated the bilateral foot pain 0%, analogously coded 5399-5310 (Group X muscle injury), citing slight injury.  The VA rated the bilateral foot pain condition 10%, 5276 (flatfoot, acquired: (pes planus)), based on the C&P examination, citing mild symptoms relieved by built-up shoe or arch support.  Members first agreed that the objective findings and associated disability for each foot were identical with minimal pathology, and concluded there was not a preponderance of evidence in the service records which overcame the presumption that the bundled plantar fasciitis condition was reasonably considered separately unfitting.  The panel then considered its rating recommendation for the unfitting foot condition at the time of separation.  

Panel members noted no loss of power or lowered threshold of fatigue which attained a minimum rating under code 5310 code for moderate disability.  The panel also considered code 5284 (foot injuries, other) and 5276 (flatfoot, acquired), but was unable to justify a compensable rating under either code based on the minimal pathology documented in the examinations proximate to separation.  Additionally, the NARSUM and C&P examiners did not note reduced ankle, fort or toe ROM, painful motion, or functional limitations on walking.  Thus, members agreed there was insufficient evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, and considering all the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bundled bilateral foot condition.

BOARD FINDINGS:  In the matter of the bilateral foot pain and IAW §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.  

AR20190006199, 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.