RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200976 SEPARATION DATE: 20021218 BOARD DATE: 20130207 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (13M10/Multiple Launch Rocket System Crewmember), medically separated for plantar fasciitis, with pain after running and standing. The CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Major depressive disorder (MDD), alcohol abuse and pathological gambling conditions, identified in the rating chart below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the plantar fasciitis condition as unfitting, rated 10% IAW U.S. Army Physical Disability Agency Policy/Guidance Memorandum #12, dated 08 April 2002. The remaining conditions were determined to be not unfitting and therefore not rated. The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: “Veteran received zero rating for disability that caused actual medical discharge from service (severe chronic plantar fasciitis). Veteran strongly disagrees with rating. Veteran received an unusually low rating (10%) for injury sustained from accident to upper back/shoulder region. Veteran strongly disagrees with these ratings. Both injuries are still prevalent.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The plantar fasciitis condition requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below, in addition to a review of the ratings for the unfitting conditions. The other requested shoulder/back condition is not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20021112 VA (3 Mos. Pre -Separation) – All Effective Date 20021219 Condition Code Rating Condition Code Rating Exam Plantar Fasciitis 5399-5310 10% Bilateral Plantar Fasciitis 5276 0% 20020925 Major Depressive Disorder Not Unfitting Mood Disorder 9435 NSC N/A Alcohol Abuse Not Unfitting No VA Entry Pathological Gambling Not Unfitting .No Additional MEB/PEB Entries. Migraine Headaches 8100 10% 20020925 Right Shoulder Strain 5014 10% 20020925 0% X 2 / Not Service-Connected x 1 20020925 Combined: 10% Combined: 20% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. Plantar Fasciitis Condition. According the MEB narrative summary dictated in August 2002, and the examination recorded in the MEB NARSUM, bilateral lower extremities had full range-of- motion (ROM), and no edema, effusion, or muscle atrophy were present. The examination of the feet noted tenderness at the arch and ball of both feet to deep palpation. The arches of both feet appeared normal and there was no edema or induration noted. The CI’s gait was normal. The VA Compensation and Pension (C&P) exam performed 3 months prior to separation revealed a normal gait and stance, normal leg length, and no signs of abnormal weight-bearing on feet. The examiner noted that the examination of the feet revealed no abnormal motion, weakness, edema, atrophy of musculature, disturbed circulation, or tenderness. The smaller joints of the feet appeared normal and there was no tenderness, alignment issues, or pain on examination. There were no claw feet, hammer toes, hallus valgus or rigidus present, and no limited function of walking and standing. The lower extremity motor strength, sensation and deep tendon reflexes were all within normal limits. The Board directs attention to its rating recommendation based on the above evidence. There is not a specific code for plantar fasciitis. The PEB rated the bilateral plantar fasciitis condition 10% rated analogously under a muscle code. The VA adjudicated a 0% percent rating analogously to code 5276 (acquired pes planus) based on the normal C&P examination. The rating criteria for acquired pes planus (5276) more nearly describes the CI’s condition of plantar fasciitis due to pes planus than the code selected by the PEB. Board members agreed that the CI’s condition did not approach the 30% rating for severe as described in the criteria under VASRD 5276 and more nearly approximated the mild (0%) than the moderate level (10%). The mild to moderate rating is for the condition whether it is bilateral or unilateral. The Board also agreed that the 0% rating under the analogous code used by the PEB was supported by the preponderance of evidence of the record including the C&P examination prior to separation. Similarly, consideration under the code for other foot injuries, diagnostic code 5284 did not attain the minimum 10% for moderate symptoms. Rating under other codes would result in no change in the rating higher than that adjudicated by the PEB. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the (bilateral) plantar fasciitis condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the bilateral plantar fasciitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Plantar Fasciitis 5399-5310 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120628, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxx, AR20130005071 (PD201200976) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)