RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2018-00398
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, Field Artillery Officer, medically separated) for “bilateral plantar fasciitis…” with a disability rating of 0%.

CI CONTENTION: “I believe the PEB underrated or did not consider all of my 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 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 - 20080328	VARD - 20080605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis…	5399-5310	0%	Bilateral Pes Planus With Bilateral Plantar Fasciitis and Heel Spurs	5276-5284	10%	20080318	
Scoliosis of the Lumbar
Spine	Not Unfitting	Lumbar Strain with Mild Lumbar
Levoscoliosis	5237	10%	20080318	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral plantar fasciitis condition began in May 2005 without trauma history. The CI was referred to podiatry and diagnosed with bilateral pes planus. His condition was treated conservatively with medication and limitation of activities. The CI was found fit to perform administrative duties in his MOS; however, he was not able to deploy with his unit due to the bilateral plantar fasciitis since he had failed treatment with orthotics, s medication and restricted duty.

The 21 December 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral plantar fasciitis. Prolonged standing exacerbated the pain while some relief could be obtained by any non-weight bearing activity. Physical examination of the feet

showed absence of swelling, good blood flow bilaterally, and normal arches of both feet. Sensory and motor function were intact.

At the 18 March 2008 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported constant pain in the bottom of both feet. He had pain and stiffness at rest, but no weakness, swelling or fatigue. While standing or walking he had pain and stiffness. Physical examination revealed normal appearing bilateral feet and no leg length discrepancy. The feet showed no signs of abnormal weight bearing or breakdown, callosities, or any unusual shoe wear pattern. The bilateral feet ROM was normal, and foot joint function for both feet was not limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. Pes planus was presentand there was painful motion of both feet. There was slight tenderness on the plantar surface of both feet, and all over aspects of the foot examination were unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB bundled the right and left foot condition under a single disability rating, analogously coded 5399-5310 (Group X. Function: movements of forefoot and toes), and rated 0%, citing the condition as ‘slight’ 0%, right and left. The PEB rated the bilateral plantar fasciitis condition 0%, coded as 5310 The VA rated the bilateral plantar fasciitis condition 10%, dual coded as 5276-5284 (acquired flatfoot – other foot injury), based on the C&P examination, citing painful motion and tenderness.

Panel members first considered whether the left and right foot conditions, having been de- coupled from the combined PEB adjudication, remained separately unfitting, and noted that the objective findings and associated disability for each foot were identical with minimal pathology. In this case, both feet were considered to fail retention standards. They were implicated by the NARSUM and the commander’s statement and both were profiled. Thus, the panel agreed that the evidence reasonably justified that the functional limitations of each condition contributed to the CI’s inability to perform his military duties; each was reasonably unfitting, and accordingly a separate disability rating is supported.

The panel then considered its rating recommendation for the unfitting foot condition at the time of separation. The panel first considered the evidence for a 10% rating of the left foot. Panel members considered the 5310 code and members agreed, the code did not sufficiently support the findings of the MEB, NARSUM or C&P examination for a higher rating consideration, plus rating the condition under code 5310 would not support a 10% rating for either foot given the pathology. The panel next considered rating under the analogous coding 5276-5284 (flatfoot, acquired (bilateral; other foot injury). The NARSUM examiner stated the CI was forced to assume a sedentary lifestyle due to his plantar fasciitis. He was unable to pass the fitness test run or walk requirement, and he was prevented from performing routine maintenance on his house, lawn, and from maintaining his standard of fitness. The C&P examination, one month before separation, documented pain on motion and tenderness. Panel members agreed, the documented pes planus throughout the STR, and the finding of tenderness, pain on use and pain on motion recorded at the C&P and NARSUM examinations, as well as the relative resistance to treatment, supports a 10% rating under the analogous coding 5276-5284. Panel members next considered the right foot and concluded, there was no evidence that the right foot was less impaired than the left, and therefore, the panel agreed, a 10% rating was justified. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the plantar fasciitis condition in each foot, coded 5276-5284.

Contended PEB Condition: Scoliosis of the Lumbar Spine. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. 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 there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the bilateral plantar fasciitis condition, the panel recommends a disability rating of 10% for the left foot and 10% for the right foot, each coded 5276-5284 IAW VASRD §4.71a. In the matter of the contended scoliosis of the lumbar spine 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.

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

CONDITION	VASRD CODE	PERMANENT RATING	
Plantar Fasciitis, Left Foot	5276-5284	10%	
Plantar Fasciitis, Right Foot	5276-5284	10%	
	COMBINED	20%	

The following documentary evidence was considered:

[AR Number]
AR20200004374

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% 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 and to the counsel you listed on your application