RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	 CASE:  PD-2013-02034	
BRANCH OF SERVICE:  Army	 BOARD DATE:  20150804
SEPARATION DATE:  20050610		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Automated Logistics) medically separated for bilateral plantar fasciitis, left shoulder pain, and right knee pain.  His conditions did not improve adequately to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3L3 profile and underwent a Medical Evaluation Board (MEB).  The left shoulder pain, right knee pain, and bilateral plantar fasciitis were found medically unacceptable, and were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral plantar fasciitis, left shoulder pain, and right knee arthritis” as unfitting, rated 20%, 0%, and 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:   His conditions were worse at separation and continue to negatively impact his daily activities.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  
   
IPEB – Dated 20050125 | VA – (3 mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bilateral Plantar Fasciitis, with Mild Pes Planus | 5399-5310 | 20% | Right Foot Plantar Fasciitis | 5399-5310 | 10% | 20050228
| | | Left Foot Plantar Fasciitis | 5399-5310 | 10% | 20050228
| | | Bilateral Pes Planus | 5276 | 0% | 20050228
| | | Left Hallux Valgus and Heel Spur | 5015-5280 | 0% | 20050228
| | | Right Hallux Valgus and Heel Spur | 5015-5280 | 0% | 20050228
Left Shoulder Pain | 5099-5003 | 0% | Left Shoulder, Rotator Cuff Injury | 5099-5003 | 10% | 20050228
| | | Left Shoulder, Residual Scars | 7805 | 0% | 20050228
Right Knee Arthritis | 5003 | 0% | Right Knee Degenerative Arthritis | 5003 | 0% | 20050228
Other Conditions x 0 (Not In Scope) | Other x 7 (Not in Scope) |
Combined:  20% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20050612 (most proximate to date of separation [DOS])   

ANALYSIS SUMMARY:   

Bilateral Plantar Fasciitis.  This CI has had a long history of foot pain.  In 2003, he was diagnosed with plantar fasciitis.  He was treated with night splinting, activity modification, anti-inflammatory drugs, and steroid injection.  In spite of all treatment efforts, his foot pain persisted and an MEB was initiated.  At the November 2004 MEB physical examination (PE), the CI reported that he was able to perform activities of daily living.  On PE of the feet, there was tenderness to palpation (TTP) of the plantar fascia, primarily along the medial aspect.  Mild pes planus (flatfeet) was noted.  In the MEB narrative summary (NARSUM), the diagnosis for his foot condition was: “Chronic bilateral plantar fasciitis.” 

On 28 February 2005, 3 months prior to separation, the CI had a VA Compensation and Pension (C&P) exam.  Posture and gait were normal.  On PE of the feet, both feet were normal in outline, and symmetric in form and function.  There was no heat, redness, tenderness, lack of stability, or lack of endurance.  Movement was not compromised. No sensory or vascular disturbance was identified.  X-rays showed bilateral pes planovalgus.

The Board directed attention to its rating recommendation based on the above evidence.  For the bilateral foot condition, the PEB used diagnostic code 5399-5310 (analogous to muscle injury), and assigned a 20% disability rating (10% for each side).  The February 2005 C&P exam was completed 3 months prior to separation and therefore had significant probative value.  At that exam, posture and gait were normal, and PE of the feet was essentially unremarkable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the bilateral foot condition (bilateral plantar fasciitis, with a finding of mild pes planus).
  
Left Shoulder Pain.  In 1997, the CI started having left shoulder pain.  There was no specific injury or trauma associated with the onset of shoulder pain.  In December 2000, he underwent arthroscopic surgery on his left shoulder.  After surgery, there was some improvement, but he continued to have problems with his left shoulder.  On 24 August 2004, he was seen by an orthopedist.  The CI reported that his shoulder pain was worse with certain activities, such as doing push-ups or doing any kind of overhead lifting.  PE of the left shoulder showed a negative apprehension sign, and nontender acromio-clavicular (AC) joint.  There was a slight decrease in muscle strength, but no atrophy of any of the peri-shoulder musculature.  Range-of-motion (ROM) was measured and showed flexion of 90 degrees (normal 180) and abduction of 140 (normal 180).  At the November 2004 MEB physical examination (PE), there was TTP of the left shoulder, and increased pain with shoulder motion.  Muscle strength was 4/5.  In the MEB NARSUM, the diagnosis for his shoulder condition was: “Left shoulder pain with impingement syndrome, status post arthroscopic stabilization.”   The CI’s physical profile (DA Form 3349) did not allow lifting over 10 pounds or performing profile.

At the 28 February 2005 C&P exam, performed 3 months prior to separation, the CI reported that the left shoulder condition did not interfere with ordinary lifting/carrying, activities of daily living, or service functions.  In general, he could sustain heavy physical activities without immediate distress.  On PE, the left shoulder was normal in outline, and symmetric in form and function.  There was no heat, redness, swelling, effusion, or muscle atrophy.  Neurological exam (motor and sensory) of the upper extremities was normal.  Shoulder ROM was normal, and occurred without restriction or pain.  For diagnosis of the left shoulder condition, the C&P examiner wrote: “Status post arthroscopic surgery in therapy of rotator cuff injury, remote.  No current pathology identified on physical examination to render a diagnosis.”  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Left Shoulder ROM
(Degrees)

Ortho ~ 10 mos. Pre-Sep
(20040824)

PT ~ 6 mos. Pre-Sep
(20041105)

VA C&P ~ 3 mos. Pre-Sep
(20050228)

Flexion (180 Normal) | 90 | 140 | 180
Abduction (180) | 140 | 95 | 180

The Board carefully reviewed all available evidence, and directed attention to its rating recommendation.  The VA determined that the left shoulder condition was essentially non-compensable, based solely on the VASRD §4.71a diagnostic codes for the Shoulder and Arm (5200 through 5203), based on ROM.  However; IAW VASRD §4.10 (Functional impairment), §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion); when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional impairment and functional loss due to painful motion of a major joint.   After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends by majority decision, a disability rating of 10% for the chronic, unfitting left shoulder condition (Left shoulder pain with impingement syndrome, status post arthroscopic stabilization). 

Right Knee Condition.  In 1995, this CI began experiencing right knee pain.  There was no specific trauma or injury associated with the onset of knee pain.  He was treated with physical therapy and other conservative measures.  On 24 August 2004, at the MEB NARSUM exam he was seen by an Orthopedist.  The CI reported a feeling of subjective instability of the right knee, with catching and popping.  He denied ever having a locked knee, and it had never actually given out on him.  PE of the right knee revealed a positive patellar grind, but no patellar instability.  Range-of-motion (ROM) was 0-145 degrees, (normal 140) with crepitus.  There was no effusion, and all tests for ligamentous laxity were negative.  X-ray of the right knee showed minimal degenerative change.   

At the 28 February 2005 C&P exam, performed 3 months prior to separation, the CI reported that his right leg and right knee condition did not interfere with his posture and gait.  In general, he could sustain heavy physical activities without immediate distress.  On PE, the right knee was normal in outline, and symmetric in form and function.  There was no heat, redness, tenderness, effusion, or muscle atrophy.  Neurological exam (motor and sensory) was normal.  Tests for ligamentous laxity were negative.  Right knee ROM was full, and occurred without restriction or pain.  For diagnosis of the right knee condition, the C&P examiner wrote: “No pathology is identified on physical examination to render a diagnosis.  Minimal osteo-arthropathy of the right knee by x-ray.”  
The Board directed attention to its rating recommendation based on the above evidence.  The 28 February 2005 C&P exam was 3 months prior to separation, and therefore had significant probative value.  At that exam, right knee ROM was normal, and occurred without restriction or pain. The Board determined that the right knee condition was essentially non-compensable, based on the VASRD §4.71a diagnostic codes for the knee and leg (5256 through 5263).  The Board then considered the provisions of VASRD §4.10 (functional impairment), §4.40 (functional loss), §4.45 (the joints), and §4.59 (painful motion); and determined that the CI’s right knee condition did not warrant a compensable rating, under those sections of the VASRD.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the right knee condition (right knee arthritis). 

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 foot condition (bilateral plantar fasciitis, with mild pes planus), and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left shoulder condition (left shoulder pain with impingement syndrome, status post arthroscopic stabilization), and IAW VASRD §4.10, §4.40, §4.45, and §4.59; the Board recommends by majority decision a disability rating of 10%.  In the matter of the right knee condition (right knee arthritis), 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 the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:   

CONDITION | VASRD CODE | RATING
Bilateral plantar fasciitis, with mild pes planus | 5399-5310 | 20%
Left shoulder pain, with impingement syndrome | 5099-5003 | 10%
Right knee arthritis | 5003 | 0%
RATING (w/ BLF) | 30%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150013285 (PD201302034)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

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