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AF | PDBR | CY2013 | PD-2013-01282
Original file (PD-2013-01282.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD -20 1 3 - 0 1282
BRANCH OF SERVICE: Army   BOARD DATE: 2014 0926
Separation Date: 20040911


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) w as an active duty SPC/E-4 (88M/ Motor Transport Operator) medically separated for pes planus with a history of plantar fasciitis. The bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The foot condition, characterized as “plantar fasciitis” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 . The I nformal PEB adjudicated “ Pes Planus with history of p lantar fasciitis” as unfitting rated at 0%. The CI made no appeals and was medically separated .


CI CONTENTION : The CI makes no specific contentions and states “Breathing problems, sleep apnea, depression, knees.”


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 pes planus condition is addressed below. The requested breathing problem, sleep apnea, depression and knee conditions were not identifi ed by the PEB and thus are not 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 20040622
 VA - (3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Pes Planus with History of Plantar Fasciitis 5299-5276 0% Left Plantar Fasciitis 5276 10% 20040602
Right Plantar Fasciitis 5276 10% 20040602
Other X 0 (Not in Scope)
 Other x 15 20040602
Combined: 0%
 Combined: 50%
Derived from VA Rating Decision (VARD) dated 20041027(most proxi mate to date of separation )


ANALYSIS SUMMARY : The Board acknowledges the presence of “breathing problems, sleep apnea, depression, knees” as sevice - connected conditions by the VA, but notes that the scope of its recommendations does not extend to conditions which were not diagnosed or in evidence at the time of medical separation. This includes conditions which may have had early manifestations during active service, since such sub-clinical conditions cannot be correlated with a fitness determination requisite for a rating.

The PEB rated the pes planus with history of plantar fasciitis condition under the single analogous code of 5299-5276 ( degenerative arthritis ) . This coding approach is countenanced by AR 635-40 (B.24 f.), but IAW DoDI 6040.44 the Board must apply only VASRD guidance to its recommendation. The Board must therefore apply separate codes and ratings in its recommendations if compensable ratings for each joint are achieved IAW VASRD §4.71a. If the Board judges that two or more separate ratings are warranted in such cases, nonetheless , it must satisfy the requirement that each “unbundled” condition was reasonably justified as unfitting in and of itself, with the caveat that the final recommendation may not produce a lower combined rating as that of the PEB.

Pes Planus with History of Plantar Fasciitis Condition . In October 2001, the CI developed atraumatic moderately severe heel pain. He tried conservative therapy on his own which was unsuccessful and he finally reported to a medical treatment facility in February 2002. An X -ray taken indicated plantar fasciitis. The CI underwent physical therapy and was prescribed orthotics which provided minor relief . During his deployment to Kuwait, he had ongoing bilateral f oo t pain. The necessity of wearing loa d bearing equipment, flak vest and the increase in activity as a truck driver caused increased feet discomfort . T he CI was given a permanent L3 p rofile for bilateral heel pain/plantar fasciitis with additional restrictions o f no running, marching, jumping and to walk at own pace/ distance. The commander’s statement documented that the CI’s medical condition made it impossible to perform his duties. The orthopedic surgeon noted that the bilateral weight bearing X-rays did not demonstrate pes planus and the podiatrist indicated that the CI’s being overweight status could be contributing to the his bilateral foot pain condition.

 The MEB narrative summary (NARSUM) exam ( approximately 7 months prior to separation ), documented that the CI reported experiencing pain 75% of the time during waking hours with disruptions of pain while sleep. The CI had an antalgic gait, difficulty bearing weight for a considerable portion of time, could n ot stand for prolonged periods greater than 15-20 minutes , unable to perform run nor complete the walk the APFT and had great difficulty performing the dutie s required of him in his MOS. The CI failed conservative therapy along with injections. An X -ray showed bilateral calcaneal spurs. The NARSUM physical exam findings revealed an antalgic gait with an obvious arch when standing. There was discomfort to pressure at calcaneal insertion of plantar fascia and severe discomfort along the entire medial aspect of plantar fascia both feet with dorsiflexion. Ankle ROM was normal. The examiner opined that the prognosis for the CI’s return to satisfactory military service performance was considered poor.

The VA Compensation and Pension (C&P) exam ( approximately 4 months prior to separation ), documented that the CI continued to undergo conservative therapy for plantar fasciitis without any improvement. The VA C&P physical exam quoted the findings of the MEB NARSUM as described above.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the pes planus with history of plantar fasciitis condition coded 5299-analagous to 5276 (acquired f latfoot [ Pes Planus ]) and rated at 0%. The VA coded the left plantar fasciitis condition as 5276 and rated at 10% and the right plantar fasciitis condition as 5276 also rated at 10%. Both the MEB and VA exams documented the same physical exam findings recorded on the MEB NARSUM. The Board considered the PEB’s adjudication of the CI’s bilateral foot condition under a single VASRD code in deliberating its rating recommendation. As noted above, there were no unilateral distinctions with regards to clinical features or fitness considerations , therefore, Board members agree that it is reasonably justified that each foot , when “unbundled” from the combined PEB adjudication, was separately unfitting and warrented a separate disability rating. The Board reviewed the evidence and members agree that the correct diagnosis in this case is plantar fasciitis, not pes planus (there was an obvious arch in both feet when standing and X -ray evidence did not support a diagnosis of pes planus). The VASRD code 5310 is most appropriate and represents the best coding option as the Group X muscle code includes “Other important plantar structures: plantar aponeurosis, long plantar and calcaneonavicular ligament, tendons of posterior tibial, peroneus longus and long flexors of great and little toes” in its rating guidelines as copied below:

5310 Group X. Function: Movements of forefoot and toes; propulsion thrust in walking. Intrinsic muscles of the foot: Plantar: (1) Flexor digitorum brevis; (2) abductor hallucis; (3) abductor digiti minimi; (4) quadratus plantae; (5) lumbricales; (6) flexor hallucis brevis; (7) adductor hallucis; (8) flexor digiti minimi brevis; (9) dorsal and plantar interossei. Other important plantar structures: Plantar aponeurosis, long plantar and calcaneonavicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes.
Severe ........................................................... 30
Moderately Severe ....................................... 20
Moderate ...................................................... 10
Slight ............................................................... 0

The Board notes that the rating options are subjective in nature and members agree that the CI’s impairment due to plantar fasciitis did not exceed the “moderate” level. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a rating of 10% for the right and 10% for the left plantar fasciitis conditions.


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 right plantar fasciitis condition, the Board unanimously recommends a disability rating of 10 %, coded 5310 IAW VASRD §4.7 3 . In the matter of the left plantar fascii tis condition, the Board unanimously recommends a disability rating of 10%, coded 5310 IAW VASRD §4.73. 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
Right Plantar Fasciitis 5 310 1 0%
Left Plantar Fasciitis 5310 10%
COMBINED (w/ BLF) 2 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 130910 , w/atchs
Exhib it 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, AR20140020445 (PD201301282)


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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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