RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

                                 BRANCH OF SERVICE:  ARMY 
           SEPARATION DATE:  20041006 

 
NAME:  XXXXXXXXXXXXX                
CASE NUMBER:  PD1101101                             
BOARD DATE:  20121012    
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (63H10, Track Vehicle Mechanic) medically 
separated for bilateral foot and ankle pain.  He developed bilateral foot pain in 1999 soon after 
entering the Army.  This was treated with orthotics, but continued to worsen over the ensuing 
years.    Podiatry  could  offer  no  surgical  remedy,  and  provided  the  various  diagnoses  listed 
below.  The conditions did not respond adequately to further conservative measures to meet 
the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards.    He  was  consequently  issued  a  permanent  L3  profile  and  referred  for  a  Medical 
Evaluation  Board  (MEB).    The  following  five  conditions  were  separately  forwarded  to  the 
Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501: bilateral pes planus, 
“abnormal  pronation,”  bilateral  plantar  fasciitis,  bilateral  posterior  tibial  tendonitis,  and 
gastrocnemius  equinus  (contracture  of  the  calf  muscle).    An  additional  combined  condition, 
“secondary low back and bilateral knee pain” was forwarded as “not boardable.”  The PEB (via 
an  Informal  Reconsideration  following  an  appeal)  conceded  aggravation  of  the  congenital 
podiatric conditions; and, consolidated three of the MEB submitted conditions (as specified in 
the PEB’s DA Form 199 language quoted below) as a single unfitting condition characterized as 
“Painful feet on [sic] ankles due to plantar fasciitis and posterior tibial tendonitis with equinus 
deformity  from  gastroc  shortening.”    The  condition  was  rated  10%  under  a  muscle  disability 
code IAW criteria of the Veteran’s Administration Schedule for Rating Disabilities (VASRD).  The 
pes  planus,  “abnormal  pronation”  and  combined  low  back/bilateral  knee  conditions  were 
determined to be not unfitting.  The CI made no further appeals, and was medically separated 
with a 10% disability rating. 
 
 
CI  CONTENTION: 
strain,  bilateral 
retropatellofemoral  syndrome,  bilateral  plantar  fasciitis.”    He  does  not  elaborate  further  or 
specify a request for Board consideration of any additional conditions.  
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (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 rating for the unfitting foot/ankle condition(s) is 
addressed below.  The application implies a request for Board consideration of separate ratings 
for  lumbar  spine  and  bilateral  knee  conditions.    Since  these  (combined)  conditions  were 
identified and adjudicated as not unfitting by the PEB, they are within the DoDI 6040.44 defined 
purview of the Board; and are accordingly addressed below.  The pes planus and “abnormal 
pronation” conditions identified by the PEB were not requested for consideration; e.g., they do 
not satisfy scope requirements.  The above conditions, or any condition or contention outside 
the Board’s defined scope of review, remain eligible for future consideration by the Army Board 
for Correction of Military Records. 
 
 

“Lumbosacral 

states 

simply, 

The 

application 

RATING COMPARISON:  
 

Service PEB (Reconsideration)  – Dated 20040910 

VA* – Effective 20041007 

Condition 

Feet/Ankles…Plantar Fasciitis... 
Tibial Tendonitis… Gastroc Equinus  
Bilateral Pes Planus 
Abnormal Pronation 

Secondary Low Back and Bilateral 
Knee Pain 

Rating 

Code 
5399- 
10% 
5310 
Not Unfitting 
Not Unfitting 

Not Unfitting 

Condition 

Code 

Ratin
g 

Exam 

Bilateral Patellar Fasciitis…Tibial 
Tendon…Equinus Deformity…Pes 
Planus 

No VA Entry 

Lumbosacral Strain 
RPS, Left Knee  
RPS, Right Knee 

5271-5020 

10% 

STR* 

5299-5237 
5299-5257 
5299-5257 

0% 
0% 
0% 

STR 
STR 
STR 
STR 

Combined:  10% 

Combined:  10% 

* STR = Service Treatment Record.  CI failed to report for VA rating examinations; earliest post-separation evidence is 2008. 
 

 

ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention for ratings for his lumbar 
spine and bilateral knee conditions which were determined to be not unfitting by the PEB, and 
notes that its recommendations in that regard must comply with governance for the Disability 
Evaluation  System  (DES).    While  the  DES  considers  all  of  the  member's  medical  conditions, 
compensation can only be offered for those medical conditions that cut short the member’s 
career; and the Board’s assessment of fitness determinations is premised on the MOS-specific 
functional  limitations  in  evidence  at  the  time  of  separation.    The  Department  of  Veterans’ 
Affairs (DVA) is empowered to compensate 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.  Should the Board judge that any contested condition was 
most  likely  incompatible  with  MOS  requirements;  a  disability  rating  IAW  the  VASRD  will  be 
recommended.    It  is  also  noted  by  the  Board  that  there  is  a  significant  interval  (4  years) 
between  the  date  of  separation  and  the  next  available  medical  evidence.    DoDI  6040.44 
specifies a 12-month interval for special consideration to post-separation findings; therefore, 
the only probative evidence relevant to the Board’s recommendations is that obtained from the 
records.   
 
Bilateral  Foot/Ankle  Condition(s).    The  CI’s  armed  forces  entry  physical  documented  no 
podiatric pathology, but he was diagnosed with pes planus less than a year later and prescribed 
inserts.    He  was  subsequently  fitted  for  orthotics  and  was  placed  on  an  L2  profile  in  2002.  
Without surgical indications, he was followed by Podiatry with a dominant diagnosis of plantar 
fasciitis;  and,  failed  to  respond  to  local  injections  and  various  other  non-invasive  modalities.  
Eleven months prior to separation a bilateral foot X-rays were reported as “normal anatomic 
alignment” with normal bones and joint spaces.  The narrative summary (NARSUM) described 
the clinical course and referred to the proximate podiatric consultation for further detail and 
examination;  and,  all  of  the  MEB  submitted  podiatric  diagnoses  were  derived  from  this 
evaluation.   The  functional  status  was  documented  as,  “Presently the  patient  is  in moderate 
pain  daily  with  difficulty  sleeping.    Difficulty  with  performing  in  his  MOS.    Difficulty  with 
soldiering  skills  and  problems  with  daily  activities.    His  functional  status  is  considered  poor.” 
The  referenced  podiatric  examination  documented  bilateral  medial  plantar  and  heel 
tenderness, low arch height, abnormal gait with excessive pronation (right > left), and “severe 
pain to palpation” over the posterior tibial tendon (Achilles’) insertion with pain on recruitment 
or  stretch  of  the  tendon.    Neurovascular  findings  were  normal  and  motor  strength  was 
documented  as  5/5.    Bilateral  ankle  dorsiflexion  was  recorded  as  5  degrees  (normal  20 
degrees),  and  there  is  no  full  goniometric  range-of-motion  (ROM)  evaluation  of  the  ankle  in 
evidence.  It was also noted that dorsiflexion was equal with the knees extended and flexed; 
raising  doubt  as to the association of the  ROM limitation  with the plantar  fasciitis,  posterior 
tibial tendon, or gastrocnemius (calf) diagnoses.   

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The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB combined the bilateral plantar fasciitis, tendonitis, and gastrocnemius equinus diagnoses as 
the single unfitting and solely rated condition.  IAW VASRD §4.7 (higher of two evaluations), the 
Board must consider separate ratings for PEB bilateral joint adjudications; although, separate 
fitness assessments must justify each disability rating.  In this case, both feet were considered 
to  fail  retention  standards;  both  were  implicated  by  the  NARSUM  and  in  the  commander’s 
statement;  and,  both  were  profiled.    Members  agreed,  therefore,  that  separate  disability 
ratings were justified in this case if advantageous to rating under the VASRD.  Furthermore IAW 
VASRD  §4.56  (evaluation  of  muscle  disabilities)  the  PEB’s  choice  of  analogous  code,  5310 
(muscle group X, plantar aponeurosis), must be applied to each affected muscle group rather 
than  bilaterally.    The  VA’s  analogous  code  5020  (synovitis)  defaults  to  general  5003 
(degenerative arthritis) criteria, and does permit its 10% rating for two or more joints; although, 
the  criterion  for  degenerative  changes  by  X-ray  was  not  met.    Members  concurred  that 
separate  ratings for the  separate MEB  podiatric  diagnoses  or  a  separate  rating  for  the ankle 
would not be compliant with VASRD §4.14 (avoidance of pyramiding).   
 
The  Board  first  considered  if  any  of  the  foot  codes  under  VASRD  §4.71a  which  do  permit 
bilateral rating were applicable to this case.  Consideration was given to analogous application 
of 5276 (acquired pes planus), since it offers bilateral ratings of 10% (not advantageous) and 
30%.    The  30%  rating  requires  “marked  deformity  (pronation,  abduction,  etc.)”  and  “pain 
[severe]  on  manipulation  and  use,”  in  addition  to  other  markers  which  were  not  present.  
Although  one  might  argue  that  ‘marked’  deformity  and  ‘severe’  pain  were  evidenced, 
conceding reasonable doubt, there are significant objections to application of the pes planus 
code.  The criteria under VASRD §4.57 (static foot deformities) are dubiously met in justification 
of acquired pes planus; and, the condition of pes planus itself was adjudicated as not unfitting 
by the PEB.  It would be difficult to argue that pes planus was intrinsically unfitting, especially 
given normal x-ray alignment, in this case.  It was rather the pain from plantar fasciitis and the 
other diagnoses that was unfitting.  Furthermore, the DoDI 6040.44 scope requirements for a 
rating based on pes planus were not met.  Therefore the Board rejected application of the 5276 
code, and there were no other applicable codes amendable to bilateral rating.  The Board then 
considered the most favorable code for separate ratings of the feet; and, concluded that since 
there was no significant difference in the clinical features or severity; coding and rating choices 
should  logically  be  identical.    Analogous  coding  as  5299-5284  (foot  injuries,  other)  was 
entertained, but this offers no rating advantage over the PEB’s choice of 5310 which is more 
clinically compatible and best aligned with the disability in evidence.  The 5310 muscle disability 
code is in common use for plantar fasciitis, and is quite acceptable when applied unilaterally.  It 
yields ratings based on ‘slight’, ‘moderate’, ‘moderately severe’, and ‘severe’ muscle disability; 
rated 0%, 10%, 20%, and 30% respectively.  Many of the VASRD §4.56 (rating muscle disability) 
criteria  are  written  for  penetrating  missile  injuries,  and  are  not  applicable  to  analogous 
application of the muscle disability codes.  Deliberations settled on the applicable criteria for 
‘moderate’  vs.  ‘moderately  severe’  as  defined  by  §4.56.    Differentiation  between  the  two 
ratings is essentially the severity and number of the “cardinal signs” of muscle disability which 
are  present;  the  latter  specified  as  “loss  of  power,  weakness,  lowered  threshold  of  fatigue, 
fatigue-pain, and impairment of coordination and uncertainty of movement.”  Fatigability and 
pain  were  clearly  present;  weakness  may  have  been  present  subjectively,  but  was  not 
demonstrated  objectively;  and,  there  was  no  indication  of  a  lack  of  coordination.    After  due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt), 
members agreed that the disability was best aligned with the §4.56 ‘moderate’ criteria; and the 
Board accordingly recommends a disability rating of 10% for each foot (including ankle) under 
the code 5399-5310.   
 
Contended  Lumbar  Spine  and  Bilateral  Knee  Conditions.    In  1999,  the  CI  developed  an  early 
history of bilateral knee pain which was diagnosed variously as retropatellar pain syndrome and 
“overuse syndrome.”  This was treated conservatively, and was never profiled (albeit possibly 

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sheltered  by  the  foot  profile).    Similarly  the  back  pain  surfaced  in  1999  (diagnosed  as 
“mechanical low back pain”), although this condition was mostly clinically silent throughout the 
military career until the MEB period.  It was likewise never profiled.  The MEB podiatrist opined 
that the knee and back problems were a consequence of the anatomical factors inherent in the 
foot pathology.   
 
The Board’s main charge with respect to these conditions is an assessment of the fairness of 
the PEB’s determinations that they were not unfitting.  The Board’s threshold for countering 
fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its 
rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable” 
standard.  Neither of these conditions was profiled; neither was implicated in the commander’s 
statement;  and,  it  was  judged  by  the  MEB  examiner  that  neither  of  them  was  subject  to 
medical boarding.  The lumbar spine and knee conditions were reviewed by the action officer 
and considered by the Board.  There was no performance based evidence from the record that 
either  condition  significantly  interfered  with  satisfactory  duty  performance.    After  due 
deliberation in consideration of the preponderance of the evidence, the Board concluded that 
there was insufficient cause to recommend a change in the PEB fitness determination for the 
lumbar spine and knee conditions; thus no additional disability ratings can be recommended. 
 
 
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/ankle  condition,  the  Board  unanimously 
recommends  that  each  foot  be  rated  as  separately  unfitting  at  10%,  coded  5399-5310,  IAW 
VASRD  §4.73.    In  the  matter  of  the  lumbar  spine  and  bilateral  knee  conditions,  the  Board 
unanimously recommends no change from the PEB determination as not unfitting.  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: 
 

VASRD CODE  RATING 
5399-5310 
5399-5310 
COMBINED (w/ BLF) 

10% 
10% 
20% 

UNFITTING CONDITION 

Plantar Fasciitis with Posterior Tibial Tendonitis and Gastrocnemius 
Equinus, Left Foot/Ankle  
Plantar Fasciitis with Posterior Tibial Tendonitis and Gastrocnemius 
Equinus, Right Foot/Ankle  

 

 

 

 

   4                                                           PD1101101 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20101110, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   5                                                           PD1101101 
 

 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20120019354 (PD201101101) 
 
 
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 20% 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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

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