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AF | PDBR | CY2012 | PD2012 01598
Original file (PD2012 01598.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1201598   SEPARATION DATE: 20091026
BOARD DATE: 20130502


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (15T10/Blackhawk Helicopter Repair) medically separated for bilateral foot pain with plantar fasciitis and pronation deformity. During basic training, the CI noted onset of bilateral foot pain and low back pain (LBP). There was no injury or trauma noted. For both pain issues, he was evaluated by podiatry, orthopedics and chiropractic practitioners and was treated with anti-inflammatory medications, physical therapy (PT) and orthotics. The CI also had a positive tuberculosis (TB) skin test and was prophylactically treated with vitamin B and icotinylhydrazine (INH) treatment. The CI did not improve adequately with treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The bilateral plantar fasciitis and acquired pronated foot deformities conditions were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. Lumbago and positive TB skin test conditions, identified in the rating chart below, were also identified and forwarded by the MEB as meeting retention standards. The PEB adjudicated the bilateral plantar fasciitis condition as unfitting, rated 10% for the right foot and 10% for the left foot for a combined rating of 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated with a 20% disability rating.
CI CONTENTION: “When my information was sent to the Medical Evaluation Board there were three conditions listed but they only gave me a rating for two.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 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 ratings for the unfitting bilateral plantar fasciitis condition requested for consideration and the not unfitting lumbago and intradermal purified protein derivative (IPPD) positive conditions meet the criteria prescribed in DoDI 6040.44 for Board purview, and are accordingly addressed below. 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 Army Board for Correction of Military. The Board acknowledges the CI’s contention that suggests ratings should have been conferred for other conditions documented at the time of separation. The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veterans Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically reevaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.


RATING COMPARISON :

Service IPEB – Dated 20090713
 VA (2 Mos. Post-Separation) – All Effective Date 20091027
Condition
 Code Rating Condition Code Rating Exam
Bilateral Foot Pain with Plantar Fasciitis 5299-5284 20% Left Foot, Plantar Fasciitis 5299-5284 10% 20091229
Right Foot, Plantar Fasciitis 5299-5284 10% 20091229
Lumbago Not Unfitting Chronic Lumbar Spine 5242-5237 10% 20091229
IPPD Positive Not Unfitting No VA Entry 20091229
No Additional MEB/PEB Entries
 Other x 0 20091229
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision, dated 20100222 ( most proximate to date of separation )


ANALYSIS SUMMARY:

Bilateral Foot Pain with Plantar Fasciitis & Pronation Deformity Condition. The narrative summary (NARSUM) prepared 4 months prior to separation, noted that during the 4th week of basic training, the CI had the onset and rapid increase of bilateral foot pain. There was no injury or trauma and his bilateral foot pain became increasingly debilitating. The CI described his constant bilateral foot pain as tearing with sharp pain with any motion. The intensity varied from 5-6/10 on his pain scale and it was worse in the morning, taking his first few steps and then again later in the day, following activities. He had daily painful flares and his foot pain was exacerbated by wearing military footwear. Relieving factors included rest, ice, heat, elevation and stretching. He was diagnosed with bilateral, mild plantar fasciitis and conservative therapy was initiated including duty restriction, non-steroidal anti-inflammatory medication and bilateral orthotics. He had no improvement and a corticosteroid injection of the left plantar fascia was performed along with night splints and custom orthotics; none of which resulted in any improvement. Eight months prior to separation, the treating podiatrist documented:

I instructed the CI that I am unable to treat him for this condition. I do not find any objective clinical evidence to indicate that he does have plantar fasciitis x-rays have been taken along with bone scans which all have been examined as normal. He has run through the full range of treatments that can be offered here. I do not believe that surgery is indicated for relief of his pain as this may cause even more pain. I initiated a permanent profile so that the patient can be reviewed in his duties status assessed.

Pertinent physical examination findings revealed moderate tenderness to palpation over calcaneal origins of the plantar fascia over the plantar aspects of both feet. There was marked tenderness to palpation and range-of-motion (ROM) over the longitudinal arches, bilaterally, extending to the 2nd and 3rd distal metatarsal regions of the plantar fascia. Both feet hyper-pronated with gait and weight bearing. Muscle bulk, tone and sensory function were normal. The skin was normal. Radiographic studies included a bone scan with no findings to suggest plantar fasciitis or metatarsal stress fracture. Plain film X-rays revealed normal bilateral feet with no plantar calcaneal spurs seen. The diagnosis was bilateral plantar fasciitis and acquired pronated foot deformities.

The VA Compensation and Pension (C&P) exam, accomplished 2 months after separation, documented that the CI was using a heating pad and stretching exercises for treatment. He was able to walk only a quarter of a mile and stand up to 25 minutes before his pain worsened. He denied any ankle pain or instability. He denied any numbness or tingling of the feet, decreased ROM of his ankle or toes, or a decrease in strength of his feet. Physical exam revealed a normal gait, but was unable to walk on his heels due to pain. There was no atrophy or deformity of the feet and his shoes showed normal wear. His feet were neurovascularly intact with no swelling or redness. Both ankles had normal ROM without pain. Plain film X-rays of both feet revealed a mild right bunion with degenerative changes. No evidence of acute fracture or dislocation seen. The diagnosis was bilateral plantar fasciitis.

The Board directs attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code of 5299-5284 (other foot injuries), rated each foot separately at 10%, moderate, for a combined disability rating of 20%. The VASRD does not have a separate code for plantar fasciitis, therefore, analogous coding is necessary as evidenced by the VA’s application of the same analogous coding and rating scheme utilized by the PEB. The VA also granted a combined evaluation of 20% for the CI‘s bilateral plantar fasciitis. Both physical exams present in this case document essentially the same level of disability. The Board adjudged this level of disability as moderate (as did the PEB and VA), exceeding mild because the pain did not respond to treatment and did not rise to moderately severe or severe as the pain did not prevent the CI from performing his daily activities. The Board also considered alternative coding and rating options that have been utilized for plantar fasciitis, specifically VASRD codes 5020 (Synovitis) and 5310 (Group X - Function: Movements of forefoot and toes). The VASRD code 5020 refers to the use of code 5003 (degenerative arthritis) for rating purposes. Under 5003, if there is adequate evidence of painful motion IAW §4.59 (as there was in this case), then a rating of 10% can be granted for each foot. With regard to the 5310 muscle code, the Board noted that there was no disorder of the muscles of the feet present, however, the 5310 code includes “other important plantar structures: plantar aponeurosis, long plantar and calcaneo-navicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes.” The ratings under this code apply separately to each foot and are based on a judgment of severity (slight 0%; moderate 10%; moderately severe 20%; and severe 30%). As stated previously, the CI’s disability level was moderate for each foot which correlates with a 10% rating for each foot under 5310. The Board recognized that rating under either of the alternative coding/rating schemes considered results in a combined 20% evaluation and would not confer any benefit to the CI. 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 plantar fasciitis and pronation deformity condition.


Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB were lumbago and IPPD positive. The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. 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. None of these conditions were profiled; none were implicated in the commander’s statement; and none were judged to fail retention standards. There was no history of injury to the CI’s low back and all radiographic imaging was normal. All were reviewed by the action officer and considered by the Board. There was no indication from the record that any of these conditions 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 any of the contended conditions; and, therefore, 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 pain with plantar fasciitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended lumbago and IPPD positive conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. There were no other conditions within the Board’s scope of review for consideration.


 RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Bilateral Foot Pain with Plantar Fasciitis and Pronation Deformity 5299-5284 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120820, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010173 (PD201201598)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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