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AF | PDBR | CY2013 | PD-2013-02199
Original file (PD-2013-02199.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02199
BRANCH OF SERVICE: Army  BOARD DATE: 20150804
SEPARATION DATE: 20050913


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Power-Generation Equipment Repairer) medically separated for a bilateral foot condition which 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 condition “bilateral plantar fasciitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions (migraine headaches, pseudo-folliculitis barbae, latent tuberculosis infection, major depression [resolved], allergic rhinitis) for PEB adjudication; all judged to meet retention standards. The Informal PEB adjudicated the bilateral plantar fasciitis as unfitting, but determined that is it had existed prior to service (EPTS) without permanent service aggravation and was not ratable. The CI appealed to the Formal PEB (FPEB), which conceded service aggravation, and rated the bilateral plantar fasciitis at 0%, citing criteria of the Veterans’ Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting (by the IPEB and FPEB). The CI made no appeals and was medically separated.


CI CONTENTION: “Feet”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.



RATING COMPARISON :

FPEB - Dated 20050524
 VA* - (~8 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Plantar Fasciitis 5399-5310 0% Bilateral Plantar Fasciitis 5299-5276 0% 20060508
Other MEB/PEB Conditions x 5 (Not In Scope)
 Other x 5
RATING: 0%
 RATING: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 60608 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis. The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) of an onset of bilateral foot pain in basic training. An STR entry from April 2003 (6 months after service entry) records pain reduced “by 50% after wearing orthotics for two to three weeks [medical shorthand translated].” Subsequent podiatry notes indicate a trial of custom made orthotics and a diagnosis of “intractable plantar fasciitis secondary to pes planus [flat feet].” Bilateral foot x-rays were interpreted as “pes planus and no acute pathology.”

The NARSUM was conducted 15 October 2004 (11 months pre-separation), and documented persistent bilateral plantar pain which had been treated with “conservative measures, taping, three different sets of custom orthotics, nonsteroidal anti-inflammatories, profiling, and physical therapy; all of this without relief.” Stated functional limitations were “unable to tolerate wearing boots ... cannot stand for greater than 15 minutes, or do any running, walking, or bicycling.” The NARSUM physical examination recorded, “The feet show marked pes planus with marked tenderness over the origin of the plantar fascia bilaterally, and this reproduces the pain of his chief complaint.” The profile and commander’s performance statement noted bilateral foot pain without fitness distinction of one versus the other.

A VA Compensation and Pension (C&P) examination was conducted 8 May 2006 (8 months post-separation), and reflected less acuity than that indicated by the NARSUM. The CI was intermittently using orthotics, and was comfortable without them at the time of the exam. He was fully employed. A detailed podiatric examination noted “no apparent abnormal weightbearing or antalgic gait ... strength +5/5 and equal ... alignment was normal upon weightbearing stance. No pain on manipulation.” Bilateral range-of-motion measurements at the ankle were dorsiflexion to 15 degrees (normal 20) and plantar flexion to 40 degrees (normal 45).

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated analogously to code 5310, the muscle disability code for Group X (movements of forefoot and toes). This code is appropriate to plantar fasciitis, but is not compliant with VASRD §4.55 (principles of combined ratings for muscle injuries) which stipulates that each muscle group must be rated separately. The VA’s bilateral 0% rating analogous to 5276 (flatfoot, acquired) was arguably consistent with the 0% criteria for 5276 (“mild: symptoms relieved by built-up shoe or arch support”), premised on the severity documented by the C&P examiner. The Board, however, must assign more probative value to the Service evidence in arriving at its recommendation, considering temporal proximity to separation. The Board also must consider separate ratings for PEB bilateral joint adjudications, IAW VASRD §4.7 (higher of two evaluations); although, separate fitness assessments must justify each Service disability rating. In this case, the plantar fasciitis was treated as a combined bilateral condition, without distinguishing right versus left, in the NARSUM, the commander’s statement, and the profile; and, it is noted that the VA rated under a single bilateral code. Members concluded, therefore, that it was speculative to presume that the disability confined to either foot would have rendered the CI incapable of continued service; and, it was reasonable to surmise that it was the combined effect from both feet which rendered him unfit.

Having determined that separate foot ratings were not justified, members deliberated the appropriate code and rating as a bilateral condition. Although it was the pain from the plantar fasciitis, as a complication of pes planus, which rendered the CI unfit; the analogous application of code 5276 (as per the VA) is a reasonable rating option in this case. The VA’s 0% rating under 5276 was reasonable based on the C&P evidence (as elaborated above), but the NARSUM evidence indicates more significant disability at the time of separation. The bilateral 10% criteria include features of malalignment with weight bearing (those specifically excluded by the VA examiner, and not addressed in the NARSUM or STR); but, as an additional criterion (sufficient in itself) cites “pain on manipulation and use of the feet.” Members agreed that this criterion was reasonably supported by the NARSUM and Service evidence. After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the bilateral plantar fasciitis condition under code 5299-5276.


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 plantar fasciitis condition, the Board unanimously recommends a Service disability rating of 10%, coded 5299-5276, IAW VASRD §4.71a. 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:

CONDITION VASRD CODE RATING
Bilateral Plantar Fasciitis due to Pes Planus 5299-5276 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131105, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








         XXXXXXXXXXXXXXXXXXXX
         President
         DoD 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 XXXXXXXXXXXXXXXXXXXX, AR20150015452 (PD201302199)
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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA


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