RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01462
BRANCH OF SERVICE:  NAVY 	BOARD DATE:  20141107
SEPARATION DATE:  20041117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (DK2/Disbursing Clerk) medically separated for a bilateral foot condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She requested and was denied a permanent limited duty [LIMDU] and was subsequently referred for a Medical Evaluation Board (MEB).  The bilateral foot condition, characterized as “calcaneal exostosis and bilateral plantar fasciitis”, was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bilateral plantar fasciitis” as unfitting, rated 20% and calcaneal exostosis as a Category II (contributing to unfit) condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Conditions may have been worse than evaluated.  The Wounded Warrior Act 1/28/08.” 

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 foot condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The Board unanimously agreed the calcaneal exostosis condition to be part and parcel of the bilateral foot conditions and will discuss it as well as the foot conditions.  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 Naval Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20041117	VA - (5 Mos. Pre-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	10%
10%
20%	Bilateral Plantar Fasciitis	5299-5276	10%	20040623	
- Calcaneal Exostosis	Cat II	Calcaneal Small Spurs w/Mild Bilateral Hallux Valgus Deformity Left Foot	5280	0%	20040623	
		Calcaneal Small Spurs w/Mild Bilateral Hallux Valgus Deformity Right Foot	5280	0%	20040623	
Other x 0 (In Scope)	Combined:  60%	
Combined:  20%		
*Derived from VA Rating Decision (VARD) dated 20041119 (most proximate to date of separation)

ANALYSIS SUMMARY:  The PEB combined both foot conditions and rated as bilateral plantar fasciitis 20%.  However, scrutiny of record of the PEB proceedings clearly reveals separate evaluations of each foot rated 10% code 5399-5310.  The Board unanimously agreed the PEB acted to rate the foot conditions separately, combining them for clerical expediency, on the final report.  Accordingly, the Board determined the each should be reviewed and rated separately as unfitting conditions.  As the foot conditions were evaluated together on most clinical examinations, the Board will discuss these conditions together, to comport with the structure of the evidence and then address rating decisions separately.

Bilateral Plantar Fasciitis Condition.  The narrative summary (NARSUM) notes the CI to develop right foot discomfort in 1994 during performance of high impact activities.  A diagnosis of plantar fasciitis was made and the condition was successfully treated with control of symptoms.  In 1997, mild symptoms returned to bilateral lower extremities which worsened, (discomfort greater with the right foot than the left foot) subsequently, the CI sought medical treatment for her feet in 2002; CI reported a 70 pound weight gain.  During the podiatry evaluation dated 9 February 2004, the CI reported improvement of symptoms with medication and topical application of ice [packs to her feet].  Surgery was suggested, but not pursued.  As of March 2004, the CI’s weight was 230 pounds.

At the MEB examination, 12 April 2004, (7 months prior to separation), the CI reported using custom orthotics and night splints with little improvement in symptoms of feet pain.  She noted her discomfort to be most acute upon arising in the morning.  During the MEB physical exam, description of gait was omitted although documentation of mild valgus deformity of feet were present; edema (swelling) and warmth along the inner arch of bilateral, right foot greater than left foot.  No callous formations were present.  Range-of-motion of the feet was slightly limited (right foot greater than left foot) by pain with greatest limitation in the right ankle.  Weight at this time was 250 pounds.

On the nonmedical assessment dated 8 June 2004, the CI’s commander commented that “[the CI] performed her duties accurately, efficiently and effectively.  However, she exhibits a noticeable discomfort, resulting from apparent persistent foot pain, presumably compounded by her weight” and he further states “if her medical condition is correctable, she is most enthusiastically recommended for retention”.

At the VA Compensation and Pension (C&P) exam (performed 5 months prior to separation), the CI reported feet pain that’s aggravated by prolonged walking, standing or running.  Examination of the feet revealed no edema (swelling) and some tenderness to palpation along both heels.  Remainder of the feet were not tender.  There were no palpable spurs.  X-rays images of her feet at this time revealed a mild bilateral valgus deformity, small bilateral heal bone spurs, but no evidence of dislocation, fracture or arthritis.  CI’s weight at this time was recorded as 250 pounds.  On clinical evaluation 6 May 2005 (6 months post separation), an examination of the feet revealed only mild ankle swelling; CI’s weight at this time was 270 pounds.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the right / left foot conditions each at 10%, for a combined 20% rating, code 5399-5310 (analogous to muscle group X, foot dysfunction “moderate”).  A higher rating of 20%, under this code, requires the foot condition to be “moderately severe”.  The VA rated the bilateral condition at 10% coded 5276 (flat-foot acquired/moderate) citing pain on manipulation with use of feet.  The next higher rating under this code, 20% for unilateral and 30% for bilateral, requires the condition to be “severe” with objective evidence of marked deformity with abnormal function (pronation, abduction), pain on manipulation, swelling on use and characteristic callosities.

Right Foot Condition:  The Board unanimously agreed the record in evidence documents the right foot condition to be more symptomatic than the left.  The Board unanimously agreed the record supports the right foot to be “moderate”.  The Board agreed the right foot condition rose to the level of 10%, but no higher under code 5310 (Muscle injury).  The Board agreed that no higher rating than 10% could be recommended under codes 5283 (tarsal malunion) or 5284 (foot injury) as a 20% rating under these codes requires the condition to be “moderate severe”.  The Board considered a rating under code 5276 (flatfoot).  The Board unanimously agreed that it could not recommend a rating higher than 10% as no evidence of characteristic callosities or marked deformity, required for a 20% rating, were documented in the record.  The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10% for the right foot condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right foot condition.  

Left Foot Condition:  The Board agreed the left foot condition to be less symptomatic than the right and to be “mild”.  The Board adjudged that the record sufficiently documented pain on motion for a 10% rating, but no higher, with application of VASRD §4.59 (painful motion).  The Board found no rating higher than 10% under any of the codes discussed above for the right foot condition.  The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10% for the left foot condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left foot condition.  In summation, the Board found no pathway to a combined rating higher than 20% for the right and left foot conditions and, thus, recommends no change in the PEB adjudication.

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 and left foot conditions and IAW VASRD §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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, 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 12 Feb 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:

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

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