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AF | PDBR | CY2014 | PD-2014-00091
Original file (PD-2014-00091.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00091
BRANCH OF SERVICE: Army  BOARD DATE: 20150115
SEPARATION DATE: 20051116


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Food Service Specialist) medically separated for a left foot condition (plantar fasciitis) with an underlying congenital condition of pes planus (flat feet) considered to be permanently aggravated by military service. The conditions could not be adequately rehabilitated 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 left foot conditions, characterized as “symptomatic pes planus on the left foot” and “left plantar fasciitis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (dyslipidemia). The Informal PEB adjudicated “plantar fasciitis left foot with underlying condition of congenital pes planus, considered permanently service aggravated” as unfitting, rated 0% with likely application of the VA Schedule for Rating Disabilities (VASRD). Th e remaining condition was determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 VASRD 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 :

Service IPEB – Dated 20050930
 VA - (1.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Plantar Fasciitis Left Foot w/ Congenital Pes Planus 5399-5310 0% Left Foot Plantar Fasciitis and Pes Planus 5276 0%* 20060102
Other x1 (Not in Scope)
 Other x7
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 60410 (most proximate to date of separation [ DOS ] )
*Code changed to 5276-5284 and rating increased to 10% on VARD dated 20080502 effective 20051117

ANALYSIS SUMMARY:

Plantar Fasciitis Left Foot w/Congenital Pes Planus Condition. The CI developed left foot pain in late 2002 without a known injury. His foot pain was most intense with the first few steps in the morning or after being off his feet for a period of time. Over the ensuing 2 years, he was treated by podiatry and primary care with the full range of non-operative modalities including custom orthotics, steroid injections and immobilization without resolution of his pain. He was evaluated with plain film X-ray, bone scan and CT scanning of the left foot. The results revealed intense activity at the left heal area and a bone spur was identified, otherwise the results were essentially normal. The commander’s statement contained the following passage:

“The soldier was currently working in his Primary MOS of 92G on active duty as a cook but has been unable to perform his job. He cannot lift heavy objects, run for great distances, and conduct PT tests.”

The narrative summary (NARSUM) addendum prepared by a specialist 5 months prior to separation noted the CI’s heel pain symptoms increased while deployed to Iraq from March 2003 to February 2004. He stated that he was on his feet constantly while deployed, wearing boots all day and started experiencing increasing pain in arch and heel. The CI stated that he experienced severe first step pain in the morning or after periods of rest, which last for about 10 to 15 minutes with pain specifically at the distal part of the heel pad, aggravated with pressure and with heel lift. Physical exam revealed a pronated left foot with antalgic gait. There was a “significant decrease in the medial longitudinal arch bilateral” but no callouses or swelling. The MEB physical exam performed 4 months prior to separation noted tender left plantar fascia with normal gait and sensation. The MEB NARSUM prepared 2 months prior to separation noted his average pain level was 8/10, and constant located on the plantar aspect of the heel and sometimes it will “spread” into the medial mid foot area. There was no numbness or tingling. The pain was aggravated by: Prolonged standing (he could stand for a maximum of 30 minutes at a time), prolonged walking (he could walk for a maximum of 1-mile), and lifting or carrying (he could lift or carry 35 pounds maximum), and he was not able to run. His pain was improved with rest. The physical exam showed bilateral moderate-to-severe pes planus, which was symptomatic on the left. There was tenderness over the plantar fascia on the left with a non-painful Calcaneal squeeze test. There was no ankle effusion with normal gait and neurovascular exam.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported that he was not given any braces, corrective shoes, or shoe inserts. He stated that the pain was still constant and had affected his usual occupation as a cook because he cannot do any prolonged standing or weight-bearing, lifting or carrying the pots or pans. He had functional limitation caused by the foot pain on standing and walking as above. Physical exam findings were that he could move the toes with no difficulty and no associated painful motion. The left foot had tenderness over the medial arch and the heel pad area. There was mild pes planus on left foot; however, the Achilles tendon was within normal in alignment. He denied fatigue, impaired endurance, and/or weakened movement.

The Board directed attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code of 5399-5310, Group X muscle injuries, and rated it at 0%, citing “slight.” The VA applied VASRD code 5276, acquired flatfoot, and also rated it at 0% citing “…evaluation is granted whenever there are mild symptoms relieved by built-up shoe or arch support.” A VARD 2 years later increased the rating to 10% effective back to the day after separation. The Board reviewed the evidence and members agreed that the correct diagnosis was plantar fasciitis. The VASRD does not have a separate code for plantar fasciitis (the predominant diagnosis in this case) therefore, analogous coding is necessary. With regard to the 5310 muscle code, the Board noted that there was no disorder of the muscles of the feet present however code 5310 includes “…other important plantar structures: plantar aponeurosis, long plantar and calcaneo-navicular ligament….” The ratings under this code are based on a judgment of severity (slight 0%; moderate 10%; moderately severe 20%; and severe 30%). The Board adjudged the level of disability in this case as “moderate” because the pain did not respond to treatment and did result in some functional limitations impacting occupational tasks as documented in the commander’s statement. The disability did not rise to moderately 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 code 5020 (synovitis). The VASRD code 5020 refers to the use of code 5003 (degenerative arthritis) for rating purposes. Under code 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. The Board recognized that rating under either of the alternative coding/rating schemes considered results in a 10% evaluation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the plantar fasciitis left foot w/congenital pes planus condition.


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 plantar fasciitis left foot w/congenital pes planus condition, the Board unanimously recommends a disability rating of 10%, coded 5399-5310 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
Plantar Fasciitis Left Foot w/ Congenital Pes Planus 5399-5310 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131224, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




XXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150010395 (PD201400091)


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                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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