RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2017-05940
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “patellofemoral pain syndrome, right knee,” and “chronic plantar fasciitis, right foot,” rated 0% each, with a combined 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 - 20060712	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	0%	No VA Examination Proximate to Separation 	
Chronic Plantar Fasciitis, Right Foot	5399-5310	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Patellofemoral Pain Syndrome, Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in late 2004 while wearing a cam boot for his right foot pain.  The pain persisted even after the boot was stopped.  The CI noted that it flared with running and excessive walking and was also worse with stairs.  Weight-bearing X-rays in January 2004 showed no bony abnormalities.  An MRI obtained in February 2005 reportedly showed no ligament damage, but a possible small contusion on his posterolateral tibial plateau was noted.

The 5 June 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain.  The CI indicated treatment had not made a significant difference in his knee pain; however, noted his knee pain was less of a concern than his right foot pain.  Physical examination showed no evidence of knee instability or tenderness of the patella or pre-patellar bursa.  There was some intermittent crepitance with visible discomfort.  Range of motion (ROM) of the right knee was recorded as “full active” ROM.  There was no VA Compensation and Pension (C&P) examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing, no loss of motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was also no pain limiting motion to support a 10% rating based on §4.59 and §4.40.  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 right knee condition.

Chronic Plantar Fasciitis, Right Foot.  According to the STR and MEB NARSUM, the CI’s foot pain began in March 2004 during a run.  He was treated with an extensive course of physical therapy and custom orthotics.  He had a cam boot for a month and did not notice a significant improvement in his foot pain.  He noted some improvement with orthotics, and was able to run again at a slow pace.  He was able to deploy to Afghanistan in March 2005 and while there, his foot pain worsened.  He was returned from theater a month earlier than the rest of his unit due to his foot and knee pain.

The 28 April 2006 MEB examination (recorded on DD Forms 2807 and 2808) 5 months prior to separation, showed mild symptomatic pes planus, and right foot pain.  At the MEB NARSUM examination, the CI complained of right foot pain that interfered with his ability to perform his duties as a military policeman.  He was currently performing deskwork.  His pain was sharp in the center of his foot and occurred with each step.  He wore his orthotics with some slight improvement in pain, but not in overall function.  He had not done any running in over a year.  Physical examination noted a limp after standing, which resolved after a few steps.  The right foot showed a moderate degree of pes planus while standing and there was significant pronation.  ROM was full without pain, and there was tenderness on the sole of his midfoot. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 0%, coded 5399-5310 (Group X), citing slight muscle injury.  A 10% rating under code 5310 for “moderate disability,” requires evidence of pathology that limits function to a moderate degree.  The panel noted the CI had full ROM; however, the NARSUM examiner noted the CI wore orthotics with slight improvement in pain, but not in overall function.  He limped, which suggests pain-limiting function.  Panel members agreed the overall evidence supports a 10% rating for moderate impairment with functional loss due to pain.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right foot condition, coded 5399-5310.

BOARD FINDINGS:  In the matter of the right foot condition, the panel recommends a disability rating of 10%, coded 5399-5310 IAW VASRD §4.71a.  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	0%	
Chronic Plantar Fasciitis, Right Foot	5399-5310	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170921 w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008264, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,					      
Enclosure