RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201314 SEPARATION DATE: 20020425 

BOARD DATE: 20130213 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Specialist/E-4 (27D10/Legal Specialist), medically 
separated for right upper quadrant (RUQ) abdominal pain of unknown etiology; and plantar 
fasciitis and heel spurs with a right calcaneous stress fracture. The CI had sudden onset of RUQ 
abdominal pain in September 2000. After extensive evaluations and treatments by various 
specialists, they were unable to find a definitive source for her persistent pain. The CI’s feet 
began hurting during Basic Combat Training in 1998. Multiple attempts at conservative 
treatment failed to provide relief. The CI could not be adequately rehabilitated to meet the 
physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. She was issued a permanent P3/L3 profile and referred for a Medical Evaluation 
Board (MEB). The MEB also identified and forwarded mild stress incontinence, identified in the 
rating chart below, as being a “non-boardable condition meeting retention standards.” The 
Informal Physical Evaluation Board (IPEB) adjudicated RUQ abdominal pain as unfitting, rated 
10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The IPEB 
noted, “Symptomatic pes planus with heel spurs and plantar fasciitis, Existed Prior to Service 
(EPTS) (moderate pes planus on enlistment physical dated 25 Oct ’97). Became symptomatic in 
basic training, no evidence of permanent service aggravation.” The IPEB did not rate the foot 
condition. The CI appealed to the Formal PEB (FPEB). The FPEB noted, “Plantar fasciitis, heel 
spurs with stress fracture of right calcaneous reported on scan in 1998. Rated as periostitis 
without loss of motion, in congenital flexible pes planus foot.” Additionally, the FPEB listed the 
foot condition as being permanently service aggravated and rated at 0%. The CI appealed the 
FPEB determination and the US Army Physical Disability Agency (USAPDA) upheld the FPEB 
adjudication and the CI separated with a combined 10% disability rating. 

 

 

CI CONTENTION: “Disability has been more disabling than originally anticipated. I’ve seen VA 
consistently & have asked to be re-evaluated without success.” 

 

 

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 and those conditions identified but not determined to be unfitting by the 
PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in 
all cases. The rated, unfitting conditions RUQ abdominal pain and foot conditions, and the mild 
stress incontinence condition as requested for consideration meet the criteria prescribed in 
DoDI 6040.44 for Board purview. Any condition or contention not requested in this application, 
or otherwise outside the Board’s defined scope of review, remain eligible for future 
consideration by the service Board for Correction of Military Records. 

 

 

 

 

 

 

 


RATING COMPARISON: 

 

Service FPEB – Dated 20020205 

VA Exam (one day pre-sep) All Effective Date 20020426 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

RUQ Pain 

8799-8719 

10% 

Abdominal Adhesions w/ Chronic 
Abdominal Pain 

8799-8719 

10% 

20020424 

Plantar Fasciitis, Heel 
Spurs with Right 
Calcaneous Stress 
Fracture 

5099-5022 

0% 

B/L Pes Planus w/ B/L Plantar 
Fasciitis 

5276 

10% 

20020424 

B/L Heel Spurs 

5015 

10% 

20020424 

Mild Stress Incontinence 

Not Unfitting 

Stress Incontinence 

7599-7512 

40% 

20020424 

.No Additional MEB/PEB Entries. 

Rt Knee Patellafemoral Syndrome 

5099-5014 

10% 

20020424 

Lumbosacral Strain 

5295 

10% 

20020424 

Residuals, Femoral Shaft Stress 
Fracture w/ Lt Leg Pain 

5299-5255 

10% 

20020424 

Residuals, Femoral Shaft Stress 
Fracture w/ Rt Leg Pain 

5299-5255 

10% 

20020424 

Tinnitus, Lt Ear 

6260 

10% 

20020424 

0% X 4 / Not Service-Connected x 3 

20020424 

Combined: 10% 

Combined: 80% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the broadly stated increased disabilities with which her service-incurred conditions 
continue to burden her. The Board wishes to clarify that it is subject to the same laws for 
disability entitlements as those under which the Disability Evaluation System (DES) operates. 
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. That role and 
authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a 
different set of laws (Title 38, United States Code). The Board evaluates DVA evidence 
proximate to separation in arriving at its recommendations, but its authority resides in 
evaluating the fairness of fitness decisions and rating determinations for disability at the time of 
separation from military service. 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 Board’s main 
charge with respect to the remaining contended condition identified by the PEB is therefore an 
assessment of the fairness of the determination that it was 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. The condition falling into this category is mild stress incontinence. 

 

Right Upper Quadrant (RUQ) Abdominal Pain Condition. The record indicates the CI was right 
handed. The narrative summary (NARSUM), 4 months prior to separation, noted that the CI 
developed RUQ abdominal pain in September 2000 which persisted despite numerous 
evaluations and treatment modalities. Extensive radiology and laboratory work-ups were 
normal. Abdominal organic pathology was ruled out. The CI was eventually referred to pain 
management for nerve block injections for suspected neuropathic pain. One service treatment 
record (STR) note did list the possible etiology as sequalea from an un-diagnosed non-rash 
presentation of shingles. Despite pain management injections, the CI’s pain was unresolved 
and a diagnosis of Allodynia was determined. The MEB examination noted the CI’s abdomen 
was soft and tender to both superficial and deep palpation in the RUQ; “otherwise negative.” A 
medical statement from the CI’s physician to the PEB, 3 months prior to separation, indicated 
the CI had intercostal neuralgia with symptoms that were severe and refractory to treatment. 
At the VA Compensation and Pension (C&P) examination, a day prior to separation, the CI 
reported constant RUQ pain extending to her back and aggravated with movement and 
described as 7/10 pain scale. The C&P examination revealed a soft abdomen with direct 
tenderness to the right upper, middle, and lower quadrants as well as the left lower quadrant. 


A medical statement from the CI’S physician to the FPEB, 3 months prior to separation, 
indicated the CI had intercostal neuralgia with severe symptoms refractory to treatment. 

 

The Board directs attention to its rating recommendation based on the above evidence just 
described. Both the FPEB and VA coded the CI’s RUQ pain condition as 8799-8719 (neuralgia; 
long thoracic nerve) at 10%. Although the FPEB and the VA had slightly different disability 
descriptions, it had no bearing on the rating. It’s appropriate for such a condition to be rated 
analogous to a disability where anatomical localization and symptoms are closely related. 
Having persistent RUQ pain as well as a diagnosis of intercostal neuralgia appropriately relates 
to VASRD code 8719. The CI’s serial examinations revealed pain as the dominating symptom 
and more often than not, the pain remained in the RUQ. There was no evidence of decreased 
ROM in her right upper extremity and it was listed as “normal” on physical exam. There was no 
evidence of pulmonary symptoms or organic changes to the chest wall or abdomen, or 
gastrointestinal/bowel complaints. There was no evidence of muscle weakness or paralysis. 
The Board considered the provisions of VASRD §4.123 (Neuritis, cranial or peripheral) and 
§4.124 (Neuralgia, cranial or peripheral). The most closely related analogous code of 8799-
8719 (neuralgia; long thoracic nerve) was adjudged appropriate. IAW VASRD §4.123 the 
highest rating level, absent organic changes, is “moderate” (10% under code 8719). 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 FPEB 
adjudication for the RUQ abdominal pain condition. 

 

Plantar Fasciitis, Heel Spurs with Right Calcaneous Stress Fracture Condition. The FPEB 
combined plantar fasciitis, heel spurs, and right calcaneous stress fracture as a single unfitting 
rated condition, coded analogously to 5099-5022 at 0%. Although this approach complies with 
AR 635.40 (B.24 f.), the Board must apply separate codes and ratings in its recommendations if 
compensable ratings for each condition are achieved IAW VASRD §4.71a. If the Board judges 
that two or more separate ratings are warranted in such cases, it must satisfy the requirement 
that each “unbundled” condition was unfitting in and of itself. Not uncommonly this approach 
by the PEB reflects its judgment that the constellation of conditions was unfitting and that 
there was no need for separate fitness adjudications; not a judgment that each condition was 
independently unfitting. Thus the Board exercises the prerogative of separate fitness 
recommendations in this circumstance, with the caveat that its recommendations may not 
produce a lower combined rating than that of the PEB. The Board’s analysis and 
recommendations regarding the separate fitness issue and potential separate rating for each 
condition entrained in the PEB’s combined rating approach is addressed. 

 

At the CI’s entrance physical, she was noted to have mild asymptomatic pes planus (flat feet). 
During basic training, she developed bilateral foot pain with activity. Over the next 4 years of 
military service she was treated with a variety of interventions including anti-inflammatory and 
pain medication, ice, rest, physical therapy, orthotics and consultations with orthopedics, and 
podiatry. The CI was diagnosed with symptomatic (congenital) pes planus and plantar fasciitis 
and placed on permanent profile. At the MEB examination the CI reported painful feet which 
throb and tingle upon “taking first steps.” Pain and numbness of this nature is very consistent, 
if not absolute for the diagnosis of plantar fasciitis. The MEB examination revealed a pronated 
stance and palpatory pain on the bottom of the foot and inside the heel. The examiner also 
stated that the CI’s condition, “…prevents the wearing of military footwear.” There was no 
evidence of abnormal areas of pressure nor callous on her feet. The podiatrist’s “Rebuttal for 
PEB Findings” discussing the CI’s diagnoses’ underlying pathology and etiology was considered 
in-depth. At the C&P examination, the CI reported constant bilateral foot pain, aggravated by 
prolonged walking and standing or after any period of prolonged inactivity. Examination 
reveals loss of the longitudinal arch with tenderness on the bottom of both feet and heels. 
There was no tenderness, swelling, or abnormal findings with the Achilles tendon nor 
fatigability, incoordination or weakness of either foot on examination. There was normal 


bilateral ankle range-of-motion (ROM). The CI reported frequent (usually bilateral) heel pain on 
many examinations. The CI had two separate bone scans performed; one in March 1998 
revealed a minor calcaneal stress fracture and another in February 2000 was normal. The STR 
reveals at least three radiologic examinations that showed the presence of bilateral heel spurs. 
The 2002 X-ray of a heel spur was an incidental finding while performing an ankle evaluation. 
The X-rays in 2000 were taken for “painful feet, especially the forefoot.” Pain of this nature in 
the forefoot (aka… the “ball” of the foot) is consistent with metatarsalgia. The CI was 
diagnosed with metatarsalgia as well as plantar fasciitis. The STR examination dated 4 June 
2001 revealed forefoot and plantar tenderness consistent with both diagnoses. However, the 
preponderance of clinical examinations indicated, more often than not, generalized plantar foot 
pain not necessarily confined to the forefoot, thus indicating that the plantar fasciitis was the 
primary and predominating condition and the presence of bone spurs was due to the plantar 
fasciitis condition. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board first considered whether each foot condition remained separately unfitting, having 
decoupled them from the combined FPEB adjudication. The Board discussed separate left and 
right heel spurs, right calcaneal fracture, and right and left plantar fasciitis conditions. The 
Board determined that the separate conditions within each foot (plantar fasciitis and heel spurs 
[and calcaneal fracture on the right]) were not independently unfitting, but that the disability 
contribution of each condition to each foot could not be separated from the unfitting plantar 
fasciitis condition. There is not a specific code for plantar fasciitis with heel spurs. The Board 
next considered if a VASRD-compliant bilateral code was applicable, or if the unfitting left foot 
and unfitting right foot conditions rated separately better depicted the CI’s disability condition 
IAW VASRD §4.7 (higher of two evaluations). The Board majority determined that each foot 
was reasonably separately unfitting and ratable. The Board considered analogous coding of 
5022 (Periostitis), 5276 (flat foot, acquired; unilateral or bilateral); 5278 (Claw foot (pes cavus), 
acquired), 5279 (metatarsalgia, unilateral or bilateral); 5284 (foot injuries, other, moderate); 
5310 (muscle group X); 5022 (Periostitis). Board deliberations focused on coding of 5276 for 
bilateral feet at 10%, or 5299-5284 at 10% for the right foot and 10% for the left foot. The 
Board majority agreed that painful motion, the underlying pathology and disability picture 
better supported the 5299-5284 10% rating for each foot condition. After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board 
majority recommends an unfit right foot condition coded 5299-5285 at 10% and an unfit left 
foot condition coded 5299-5285 at 10%. 

 

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s 
determination that the mild stress incontinence condition was not unfitting. Although the CI 
reported frequent awakenings at night to urinate, as well as leaking urine with exercising, 
sneezing, and coughing as per the C&P examination, there was no documented evidence that 
her urinary stress incontinence prohibited the performance of those duties required of her 
MOS. The stress incontinence condition was not profiled nor judged to fail retention standards. 
All documents were reviewed by the action officer and considered by the Board. There was no 
performance based evidence from the record that indicated the mild stress incontinence 
condition significantly interfered with satisfactory performance of military duty. After due 
deliberation in consideration of the preponderance of evidence, the Board’s consensus was 
that there was no citable evidence which would challenge the FPEB’s fitness conclusion; and, 
there were no clinical features or specific functional limitations which would render the mild 
stress incontinence condition inherently unfitting. Therefore, no additional disability rating 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. In the matter of the RUQ 


pain condition, the Board concluded that this condition could not be recommended for an 
additional disability rating and IAW VASRD §4.71, the Board unanimously recommends no 
change in the FPEB adjudication. In the matter of the plantar fasciitis, heel spurs with stress 
fracture of the right calcaneus condition, the Board, by a vote of 2:1, recommends that each 
foot be separately adjudicated for a disability rating and a change in the VASRD code. It 
recommends an unfitting right plantar fasciitis, heel spurs with stress fracture right calcaneus 
condition coded 5299-5284 and rated 10%; and, an unfitting left plantar fasciitis, heel spurs left 
foot condition coded 5299-5284 and rated 10%, both IAW VASRD §4.73. The single voter for 
dissent (who recommended code 5276 at 10% for the bilateral plantar fasciitis, heel spurs 
condition) did not elect to submit a minority opinion. In the matter of the contended mild 
stress incontinence condition, the Board recommends no change from the FPEB 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 and that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of her prior medical separation: 

 

UNFITTING CONDITION 

VASRD 
CODE 

RATING 

Right Upper Quadrant (RUQ) Pain 

8799-8719 

10% 

Plantar Fasciitis, Heel Spurs with Stress Fracture of Right Calcaneus 

5299-5284 

10% 

Plantar Fasciitis, Heel Spurs Left Foot 

5299-5284 

10% 

COMBINED (Incorporating BLF) 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120619, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxxx, AR20130003949 (PD201201314) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)