RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX.	CASE:  PD-2021-00062
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty  E6, Information Systems Operator-Analyst, medically separated for “bilateral plantar fasciitis, secondary to pes planus” and “migraine headaches, without aura, non-prostrating,” rated 0% for each with a combined disability rating of 0%.  

CI CONTENTION:  The CI submitted a lengthy contention requesting the panel consider his not previously diagnosed congestive heart failure (CHF) which was not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20021209	VARD - 20030814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis, Secondary to Pes Planus	5299-5276
5399-5310	0%	Bilateral Pes Planus with Plantar Fasciitis	5276	0%	20030603	
Migraine Headaches, without Aura, Non-Prostrating	8100	0%	Migraine Headaches	8100	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis, Secondary to Pes Planus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s plantar fasciitis condition began about a year before the MEB NARSUM examination approximately in October 2001.

The 31 October 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral foot pain aggravated with walking and standing.   Physical examination revealed normal range of motion (ROM), and motor strength in bilateral feet.  There was tenderness to the medial aspect of the heels.  Neurological examination was normal and he had a normal gait.

At the 03 Jun 2003 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported his bilateral foot pain began after he gained weight from steroid therapy and chemotherapy for Lymphoma condition.  He continues to have recurrent episodes of pain in his feet.

Physical examination showed normal gait, equal leg length, bunions of both great toes, and no calluses or hallux valgus deformity.  There was bilateral pes planus, some tenderness of both heels and the medial aspect of both feet.  Achilles tendon was with good alignment.  There was no evidence of painful motion with dorsiflexion of the toes, no limitation of ankle movement.  Weight bearing and non-weight bearing x-rays showed normal bilateral foot.

 The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0%, analogously coded 5299-5276 and 5399-5310 (flatfoot, acquired, pes planus; foot muscles, Group X, plantar fasciitis), rated as slight.  The VA also rated the bilateral foot condition 0%, coded 5276, based on the C&P examination, citing mild symptoms, improved with shoe arch support.  

The panel first considered if foot condition, when decoupled from the combined PEB adjudication, remained separately unfitting as established above.  Both feet were considered to fail retention standards and were implicated in the NARSUM.  The commander statement and other STR evidence did not provide any information which would permit the panel to discriminate the performance limitations attributable to either foot over the other.  Since undue speculation would be required to conclude that impairment from either foot would not have unacceptably interfered with MOS performance, members agreed that each foot was reasonably justified as separately unfitting.  

Panel members considered that the objective findings and associated disability for each foot were identical, and agreed that the respective ratings should therefore be the same. The NARSUM examination noted tenderness about the heels, and absence of painful motion with full range of motion, and normal motor strength.  Gait was normal.  The C&P examination, proximate to separation, recorded some tenderness of both heels and the medial aspect of both feet.  Achilles tendon was with good alignment.  There was no evidence of painful motion with dorsiflexion of the toes, no limitation of ankle movement. Gait was normal.  No foot deformity was found in either examinations; however, pes planus was present, but x-rays noted above, did not confirm pes planus.  Panel members agreed, there was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) for either foot. 

After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right foot condition, and 0% for the left foot condition, coded 5299-5276 and 5399-5310.

Migraine Headaches, w/out Aura, Non-Prostrating.  According to the STR and MEB narrative summary (NARSUM), the CI’s migraine headache condition began sometime in the year 2000.  The 31 October 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of intermittent daily headaches at an intensity of 3, on a scale of 1-10, with 10 being worst.  Head CT scan was negative for acute process.  Physical examination recorded normal head and neck exam, and normal neurological exam.  

At the 03 Jun 2003 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported a 12 year history of headaches that was not diagnosed until 2002.  His headaches were usually on one side of the head, and were pounding in nature.  He had flare ups every few days and on each occasion they lasted about 1-2 days.  Medication provided relief.  During the severe flares he normally found it difficult to function.  Physical examination was unremarkable for the condition.  The examiner noted the diagnosis of migraine headaches was a diagnosis of exclusion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraine headaches 0%, coded 8100, (migraine headaches). The VA also rated the migraine headaches 0%, also coded 8100, based on the C&P examination, citing the headaches were non-prostrating.  Rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further define prostrating attacks, however commonly accepted definitions include “utter physical exhaustion or helplessness” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  The panel carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.  The panel considered the NARSUM, C&P, and clinic examinations along with the evidence of the treatment records at the time most proximal to separation to accurately assess the overall disability picture (§4.2) at the time of separation.  Panel members concluded, review of the record did not show prostrating headaches occurring on average once every 2 months, or more frequently, over the last several months prior to separation to support a rating higher than the 0% adjudicated by the PEB.

After due deliberation, considering all 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 headache condition.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the migraine headache condition and IAW VASRD §4.124a, 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20210520, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20210017096,XXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX:

	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,