RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01432
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150401
SEPARATION DATE:  20050525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-5 (Aviation Structural Equipment Technician) medically separated for a left foot condition.  The left foot condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards and referred for a Medical Evaluation Board (MEB).  “Mid-foot pain with prolonged standing, exercise, & running, DNEPTE” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “mid-foot pain with prolonged standing, exercise and running” as unfitting, rated 10% and “left foot endoscopic plantar fasciotomy” as a related Category II diagnosis.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Im still having numbness in my left foot after surgery,”

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 (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: 

IPEB – Dated 20040707	VA* - (~17 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mid-Foot Pain 	5279	10%	Plantar Fasciotomy, Left Foot	5299-5284	10%	20031231	
Left Foot Endoscopic Plantar Fasciotomy	Category II					
Other x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20051220 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Foot Condition.  The narrative summary noted the CI developed pain in the bottom of his left foot while pulling a heavy load in June 2002.  A diagnostic ultrasound in August 2002, revealed evidence of plantar fasciitis and a partial tear of the left plantar fascia.  Despite treatment, a chronic pain condition developed in the left foot felt secondary to “plantar fasciitis.”  In October 2002, a surgical release of the plantar fascia of the left foot was performed endoscopically.  Notes in the service treatment record indicate the CI was given custom orthotics.  He was released to return to normal work activity in February 2003 by the podiatrist, with the caveat that he may continue to experience some discomfort for an additional 3 to 6 months.  However, pain in the bottom of the foot recurred and the CI was referred to physical therapy (PT).  A PT note dated 30 July 2003 indicated the CI was referred for left foot pain and was somewhat improved after three PT sessions, but reported recurrent pain with prolonged ambulation on iron cross beams at work.  At a 29 August 2003 PT visit, the CI reported some additional improvement, but continued pain in the center of the bottom of his foot when he walked on rebar or with prolonged walking on uneven surfaces.  The exam noted normal ankle range-of-motion (ROM) with pain with resisted plantar flexion and a “positive plantar fasciitis test.”  The CI was discharged from care with a home exercise program.

At the VA Compensation and Pension (C&P) exam performed on 31 December 2003, 17 months prior to separation, the CI reported working as an ironworker, doing considerable climbing and walking on beams.  He reported sharp pains with “twitches “in his foot and leg with tingling, and numbness of the ankle and entire foot once a week.  On physical examination, there was mild swelling of the inner aspect of the foot near the heel, with tenderness under the arch of the left foot.  There was moderate pes cavus deformity of the foot with intact plantar fascia and no calluses.  ROM of the left ankle and toes was normal, without pain or instability.  Sensory examination was normal.  Surgical scars were well-healed, stable, and non-tender.

At the MEB exam on 13 May 2004, 12 months prior to separation, the CI reported mid-foot pain with continued activity.  The MEB physical exam noted a normal gait.  There was no tenderness to palpation or with stressing the mid or hind foot or the great toe.  Shooting pain from the foot to the left knee was reported.  The arches were described as normal and equal in both feet.  There was normal strength without sensory disturbances and ROM of the foot and ankle were normal.  Routine X-rays of the left foot with weight-bearing views revealed no evidence of fracture, subluxation or dislocation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the foot condition at 10%, coded 5279 (Metatarsalgia) and the VA rated it 10%, coded 5284 (Foot injury/ moderate).  The Board noted that a 10% rating was achieved with any one of multiple coding approaches IAW §4.71a-5279, 5284, or 5278 (pes cavus acquired).  The Board reviewed to see if a higher evaluation was achieved with any applicable code.  The highest evaluation available under 5279 is 10%.  The rating criteria of 5284 are subjective and a higher rating of 20% requires the condition to be “moderately severe.”  Board consensus was that the foot condition was mild to moderate given the findings of both the MEB and C&P exams, including normal gait.  The 20% rating criteria of 5278 requires limitation of ankle dorsiflexion (DF), toes tending to be in DF, shortened plantar fascia, and marked tenderness under the metatarsal heads, none of which were present in this case.  Additionally, there was no evidence of flat foot, or malunion or non-union of the tarsal or metatarsal bones to support a higher rating.  The Board also considered rating analogously to 5310 (Group 10 function) for plantar fasciitis IAW §4.73 (muscle injuries) but found the rating criteria were subjective as well, with a 10% rating for “moderate” foot injury and 20% for “moderately severe.”  By the same reasoning as noted above for 5284, Board consensus was the CI’s condition was best described as moderate and rated 10%.  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 adjudication for the left 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 left foot condition and IAW VASRD §4.71a, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130916 
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) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 25 Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN