RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2011-00634
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140314
SEPARATION DATE:  20031130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (0231, Intel Analyst) medically separated for a bilateral heel condition.  The CI underwent plantar fascial release on the right foot in October 2000 and then had the same procedure on the left foot in November 2001.  After surgery, his bilateral foot pain persisted, and did not improve adequately to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He underwent a Medical Evaluation Board (MEB).  The bilateral heel condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic heel pain, status post plantar fascial release, still symptomatic” as unfitting, rated 20% (bilateral factor applied) with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My condition that I was discharged for and initially rated for was misdiagnosed.  I was originally medically separated due to plantar fasciitis, but my diagnosis is RSD bilaterally in both feet.  I have become total and permanently disabled by the VA due to secondary depression caused the RSD in both feet.  I am no longer able to work according to social security and VA vocational rehab.  The VA is completely done with my appeal at this time.”

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 bilateral heel condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service  IPEB – dated 20030930	VA – (2 mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Heel Pain, Status Post Plantar Fascial Release for Plantar Fasciitis, Still Symptomatic	5399-5310	10%	Plantar Fasciitis with Pes Planus, Status Post Plantar Fascial Release with Scars, Left Foot	5284	10%	20030912	
	5399-5310	10%	Plantar Fasciitis with Pes Planus, Status Post Plantar Fascial Release with Scars, Right Foot	5284	10%	20030912	
No Additional MEB/PEB Entries	Other x 5	20030912	
Combined:  20%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20040426 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his condition continues to burden him; but, must emphasize that the Disability Evaluation System 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 Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Chronic foot pain.  This Marine has had a long history of bilateral foot pain due to plantar fasciitis.  He was treated with custom arch supports, heel pads, anti-inflammatory drugs, steroid injections and physical therapy.  In October 2000, he underwent plantar fascial release on the right heel.  Thirteen months later he had the same procedure on the left heel.  After surgery, the foot pain was not better, in fact it was worse.  When the CI could not perform his assigned military duties, an MEB was initiated.  The MEB narrative summary is dated 6 June 2003.  Physical examination (PE) of the feet at that time revealed loss of the normal longitudinal arch of both feet.  There was mild tenderness to palpation (TTP) on the dorsum of the left first metatarsal.  The midtarsal and hindfoot joints were supple.  Motor strength and range-of-motion appeared to be intact bilaterally.  In September 2003, 11 weeks prior to separation, the CI had a VA Compensation and Pension exam.  PE of the feet showed no rigidity, spasm, circulation disturbance or swelling.  There were no signs of painful motion, edema or instability.  There was some TTP of the mid-plantar surfaces and heels bilaterally; but no hammertoe, high arch, claw foot or hallux valgus deformity.

The Board carefully reviewed all available evidence and directs attention to its rating recommendation.  The Navy PEB and the VA chose different coding options for the foot condition.  The PEB used diagnostic code 5399-5310 (analogous to muscle injury) and assigned a 10% rating (moderate) for each foot.  The VA used diagnostic code 5284 (foot injury) and also assigned a 10% rating (moderate) for each foot.  Following a thorough review of the evidence, the Board determined that IAW VASRD §4.71a and §4.73, the CI’s foot condition was best described as “moderate.”  The record did not show sufficient evidence to support classifying the condition as “moderately severe” or “severe.”  After due deliberation, the Board determined that a separation disability rating of 10% for each foot was warranted.  The Board tried to find a path to a higher rating, using other codes which could be applied to the foot condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling foot condition which would justify a higher rating.  Considering all 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 bilateral foot 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 bilateral foot condition and IAW VASRD §4.71a & §4.73, the Board unanimously recommends no change in the PEB adjudication.  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	
Chronic right heel pain, status post foot surgery for plantar fasciitis	5399-5310	10%	
Chronic left heel pain, status post foot surgery for plantar fasciitis	5399-5310	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Aug 14

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC