RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01403
BRANCH OF SERVICE:  Army	BOARD DATE:  20141016
SEPARATION DATE:  20040918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (19K, M1/Armor Crewman) medically separated for bilateral foot pain.  The bilateral foot pain condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The bilateral foot condition, characterized as “plantar fasciitis (PF)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral foot pain with clinical assessment of plantar fasciitis” as unfitting, rated 20%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “When I was separated I was issue 20%.  When I got out they gave me a 0%, now I have a 10%.  (The Wounded Warrior Act).”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting bilateral foot condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records.  

RATING COMPARISON:

Service IPEB – Dated 20040701 | VA
Condition | Code | Rating | Condition | Code | Rating | Exam
Bilateral Foot Pain with Clinical Assessment of Plantar Fasciitis | 5399-5310 | 20% | Bilateral Plantar Fasciitis | 5299-5276 | 0%* | Not available
Other x 0  (Not in Scope) | Other x 0 (Not in Scope) | Not available
Combined:  20% | Combined:  0%
Derived from VA Rating Decision (VARD) dated 20070725 (most proximate to date of separation [DOS]).
*Rating increased to 10% in 2007 utilizing foot code 5299-5279 (metatarsalgia, anterior (Morton’s disease)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

The Board acknowledges that the original VA Compensation and Pension (C&P) examination and VARD (2004 timeframe) were not in the available records.  Since the CI was initially rated 0% or non-compensable rating by the VA it was not suspected that the missing evidence would significantly alter the Board’s recommendations.  The noted documents were later received and reviewed by all Board members.  The VA C&P performed on 16 July 2004 noted the CI had a normal posture and gait with tenderness over the plantar fascia and normal foot structure, except for the mild pes cavus noted on X-rays, with normal lower extremity strength, sensation and reflexes.  The VA examiner noted that the CI reported improvement in his foot pain since curtailment of strenuous military activities.  The VARD dated 24 September 2004 rated the bilateral PF at 0%.  The VARD dated 3 March 2008 increased the rating of the bilateral PF to 10%.  Later VARDs in record to 19 April 2010 did not increase the rating.  Board members agreed that these documents would not have altered the outcome of the Board’s deliberations as detailed below.

Bilateral Foot Pain/Plantar Fasciitis Condition.  The narrative summary noted the CI first developed foot pain in the arch of his feet during basic training.  The service treatment record indicate acute care treatment in January 2003 for left PF and all subsequent treatment notes indicate treatment for PF of the left foot until an undated podiatry consult discussed below.  Left foot X-ray completed on 24 February 2003 was normal.  Physical therapy evaluation on 28 February 2003 noted a mild varus stance at the knees, with high foot arches, greater on the right than left, with tenderness to palpation of the left heel, but not the right.  The podiatry consultation, noted above, indicated anterior pes cavus with hyperpronation upon standing.  On examination, normal range-of-motion (ROM) and reflexes were noted with tenderness to palpation bilaterally; the diagnosis was bilateral PF, greater on the right and a MEB was recommended.  Bilateral weight bearing foot X-rays performed on 24 June 2004 were noted to be normal with “slight pes cavus,” no pes planus.

At the MEB examination on 18 March 2004, approximately 6 months prior to separation, the CI reported continued discomfort of both feet.  The MEB physical exam noted a slight antalgic gait (on the left), without gross abnormality of the feet to inspection.  Foot dorsiflexion caused plantar fascia pain bilaterally, with normal ankle ROM with intact sensation and pulses.  The original VA C&P examination is not the available in the records as noted above and there was no VA C&P examination of the feet in the records within 12 months of separation.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral PF 10% for each foot, coded 5399-5310 (analogous coding for PF according to muscle injury criteria), with the combined rating of 20% (with bilateral factor).  The original VARD was not in the records as noted above.  The VARD dated 25 July 2007 indicated that the VA rating of 0%, coded 5299-5276 (analogous coding of PF to acquired flatfoot) effective the day after separation on 19 September 2004, was continued.  The Board noted the CI received a combined rating of 20% for bilateral PF from the PEB.  The Board may not recommend a lower combined rating than that conferred by PEB IAW DoDI 6040.44.  The Board therefore, only reviewed to see if a higher combined rating was achieved with any applicable VASRD code.  Utilizing the PEB’s coding choice of 5399-5310, rating analogously to muscle injury IAW §4.73, the Board agreed that neither foot met the next higher evaluation of 20% for moderately severe muscle injury characterized by loss of deep tissue or muscle with impaired strength and endurance.  Utilizing the three applicable codes IAW §4.71a; 5276 and 5279 (metatarsalgia) or 5278 (acquired claw foot (pes cavus)), did not achieve a rating greater than 10% for each foot, in fact they are all rated at 0% to 10% whether unilateral or bilateral, unless there are marked abnormal findings of the foot such as pronation or abduction deformity, swelling on use, callosities or toe dorsiflexion, limited ankle dorsiflexion or shortened PF, none of which were present in this case.  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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the bilateral PF 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150004182 (PD201301403)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01403