RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02184
BRANCH OF SERVICE:  Army	BOARD DATE:  20141028
SEPARATION DATE:  20011205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31U/Signal Support Systems Specialist) medically separated for chronic bilateral plantar fasciitis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic bilateral plantar fasciitis was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic bilateral plantar fasciitis as unfitting, rated 0% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “VA has found another condition in which I was not previously awarded, and that I am currently being medically treated for.”

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 chronic bilateral plantar fasciitis 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 20011011 | VA - (6 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Bilateral Plantar Fasciitis | 5399-5310 | 0% | Pes Planus With Plantar Fasciitis, Bilateral | 5276 | 10% | 20010604*
Other x 0 (Not in Scope) | Other x 0 |
Rating:  0% | Rating:  10%
Derived from VA Rating Decision (VARD) dated 20020118 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Bilateral Plantar Fasciitis.  The available treatment record noted the CI was diagnosed with bilateral pes planus in December 1998 and developed non-trauma related arch pain.  He sought care with a podiatrist and was prescribed medication and physical therapy (PT).  PT entry dated 5 January 2000 noted the CI had a 6-month history of bilateral foot pain diagnosed initially as plantar fasciitis.  The plantar fasciitis was recorded as right greater than left.  Podiatry consultation dated 26 April 2000, indicated the CI reported discomfort in the instep area of both feet, most severe on first weight bearing after rest.  The examiner noted the CI was treated with ultrasound, stretching exercises, night splints and Motrin.  His pain persisted.  Physical examination noted discomfort on palpation around the medial plantar fascial bands, bilaterally, without evidence of inflammation.  The physician diagnosed bilateral plantar fasciitis and ordered orthotics.  Radiographs of the right foot on 7 June 2000 were normal.  Podiatry clinic encounter on 24 April 2001, noted the CI had failed conservative treatment and his overall condition was unchanged.  Treatment records were sparse.  The commander’s statement noted the CI’s physical performance significantly declined secondary to his foot condition.  The narrative summary dated 18 June 2001, recorded the CI experienced severe pain in the feet with running, marching, jumping and road marching.  The pain persisted after activity and was worsened by activities that required the CI to be on his feet.  The podiatrist noted the condition of pes planus was diagnosed in December 1998 and the CI had a temporary profile and used arch supports during that time.  His arch pain continued and he had multiple temporary profiles. 

Physical examination of the feet recorded bilateral tenderness to palpation about the balls of both feet with no other additional clinical finding.  Bilateral plantar fasciitis was recorded and the examiner opined further treatment or surgery was not indicated.  The examiner noted the CI was able to walk half a mile at own pace and distance with minimal discomfort.  However, he was unable to run, jump, march, ruck march or stand for prolonged periods of time without severe bilateral foot pain.  The examiner continued the diagnosis of bilateral plantar fasciitis, noted the 2000 right foot X-rays were normal, but made no reference to the existence of any left foot radiographs. The physician opined the CI’s condition failed to meet medical retention standards.  The VA Compensation and Pension (C&P) examination was not available for review; however, the VARD documented the findings of the examination.  The CI had a difficult time walking on his toes secondary to pain in his feet.  He had pain to palpation of the balls of both feet and radiographs demonstrated very mild pes planus deformities bilateral without evidence of any other bony abnormality.  The examiner diagnosed moderate bilateral pes planus and bilateral plantar fasciitis.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0%, coded analogously 5399-5310 (Group X, movements of foot muscles, and other plantar structure).  The VA rated pes planus with plantar fasciitis, bilateral, at 10%, coded 5276.  A 10% rating under code 5310 requires the demonstration of a moderate degree of impairment in the function of muscles, ligaments or tendons of the foot.  Such would not have been supported by the record in evidence.  The Board deliberated if this code reflected the CI’s condition and if there were other more appropriate codes to consider.  The Board considered code 5276 (flatfoot, acquired) and noted a compensable rating required evidence of anatomic abnormalities although “pain on manipulation and use of the feet” is included in the rating description and was identified at the C&P exam.  The Board discussed the criteria elaborated in VASRD §4.57 (static foot deformities).  All Board members agreed VASRD §4.57 would not support a rating under code 5276 for pes planus as an acquired condition.  The acquired condition requires the presence of anatomical changes in the relationship of the leg to the foot that would create an unfavorable mechanical relationship; however, an analogous use of the code would be appropriate to consider.  The Board considered an analogous rating under the 5299-5276 code; analogous application of 5299-5284 (foot injuries, other); or analogous application of 5099-5024 (tenosynovitis).  Any of these would achieve a minimal compensable rating of 10% if §4.40 (functional loss) was applied.  The MEB examiner noted the CI’s condition of pain interfered with daily activities.  The CI experienced pain with activity that persisted at the cessation of activity.  The commander’s statement noted a marked decline in physical ability to perform his duties due to the foot condition.  The Board concluded the evidence supported the minimal compensable rating under §4.40 (functional loss), coded 5299-5276.  After due deliberation, considering all of the evidence and mindful of the VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% IAW VASRD § 4.40 coded, 5299-5276 for the chronic 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 chronic bilateral plantar fasciitis condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5276 IAW VASRD §4.40.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Bilateral Plantar Fasciitis | 5299-5276 | 10%
RATING | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131102, 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, AR20150007091 (PD201302184)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

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.   

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

PD-2013-02184