RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXX	CASE: PD‐2013‐01772
BRANCH OF SERVICE: NAVY	BOARD DATE: 20140624 SEPARATION DATE: 20040525

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty HM3/E‐4 (HM/Hospital Corpsman) medically separated for chronic foot pain and heel pain. Her condition could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). No other conditions were submitted by the MEB. The MEB characterized her condition as “chronic foot pain and heel pain, secondary to pes planus (flat feet) foot type.” The Informal Physical Evaluation Board (IPEB) adjudicated her “chronic foot pain and heel pain,” as unfitting and rated it 20%. The CI made no appeals and was medically separated.

CI CONTENTION: “In 2002, 2 yrs before I was found unfit for service I was already very sickly. I had sleep apnea, positive for strep more than 6 times a year. Undergone tonsillectomy. I was being seen by a doctor at Little Creek Amphibious Base for irregular menstruation or lack off. She gave me oral Depo Preva for a year. In 2003 she sent me to Naval Hospital Portsmouth, VA to see an OB‐GYN specialist. That is when my nightmare begun. The specialist doctor put me on fertility drugs despite the fact that the lab works shows I have hyperplasia on the uterus which is a precursor for cancer. I undergone 3 D&C to manually scrape my uterus because according to the doctor the lining was getting thick and not shedding.   After the 1st  D&C I
started to bleed for 3 weeks or a month at a time. It was a mess I was soaking even my bed with blood. I had no continuation of care I only saw my doctor 2x or 3x at most because they were being deployed to Iraq. On to a new doctor. I was getting worse at a lost, I cannot concentrate at work, I was depressed. I had to see a psychiatrist who diagnosed me bipolar. I started gaining weight, I failed my PRT. First meeting with the Podiatrist he said he was going to process me out of the US Navy. April 2004 I was discharged from the US Navy without my other medical problem being resolved. June 2004 (2 months) after being found unfit for service I was diagnosed with 1 stage cancer of the uterus. I was operated on Sept 2004 at Travis, AFB, CA. Total hysterectomy which rendered me barren unable to have children. Today my health is getting worst I was just recently diagnosed with diabetes. Please help me FIND JUSTICE!”

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 foot and heel pain condition is addressed below; no additional conditions are within the Board’s defined DoDI
6040.44 purview. 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 20040121		VA ‐ (Exam ~ 7 Mos. Pre‐Separation)	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Chronic Foot Pain and Heel Pain	5399‐5310	10%		Bilateral Plantar Fasciitis with Heel Spur of Right Foot	5276	10%	20031020	
	5399‐5310	10%						
Other x 0 (Not in Scope)		Other x7	20031020	
Combined: 20%		Combined: 50%	
Derived from VA Rating Decision (VARD) dated 20040617 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Chronic Foot and Heel Condition. The CI developed bilateral foot pain in mid‐2000 without a specific injury noted. She was evaluated and treated with non‐steroidal anti‐inflammatory drugs and fitted with custom orthotics. When her pain did not respond, plain film X‐rays were taken and revealed mild medial subluxation of the sesamoid bone and mild right calcaneal spurring. She had been placed on LIMDU several times totaling more than four  months duration. The non‐medical assessment contained the following passage:

Although xxxxxxxxx is a fine sailor and Laboratory Technician it is my feeling that her medical condition negatively impacts both her ability to perform in‐rate duties and her ability to deploy or mobilize. The medical recommendation of her surgeon places extreme limits on the member's ability to perform day‐today functions. Additionally the member cannot be assigned to mobilization platforms or deployed aboard ship, both duties crucial to the Hospital Corps rate.

At the VA Compensation and Pension exam performed 7 months prior to separation, the CI reported chronic plantar fasciitis and heel spur. She had pain at rest and pain with standing and walking. She had no surgical procedures. The functional impairment was she could not stand for long periods of time, could not walk or run for any long periods of time and she had daily foot pain. It affected her quality of life as some times she was unable to sleep due to the chronic pain. The physical exam revealed an antalgic gait without the use of assistive devices. She did not have any calluses or any unusual shoe wear pattern. She had flat feet with moderate tenderness on palpation of the plantar surface bilaterally. Her Achilles tendons had good alignment weight bearing and non‐weight bearing. There was no limitation of ankle range‐of‐motion and non‐painful movement of her toes. The diagnosis was bilateral plantar fasciitis and heel spurs, which were noted in the medical record and plantar fasciitis was based on examination. The narrative summary prepared 7 months prior to separation noted that this CI had a longstanding complaint, since the year 2000, three years total, of pain and discomfort in the in‐steps of both heels. She tried conservative treatment of wider shoes, padding, rest, anti‐inflammatory medications and still had generalized heel pain. Custom orthotics was made with only 50 percent relief and that it was down to only 30 percent relief with chronic heel pain and plantar fasciitis. The physical examination revealed rear foot valgus, subtalar joint pronation and abducted forefoot all contributing to her plantar fasciitis and chronic heel pain. X‐rays were consistent with a pes planus foot type. The diagnosis was chronic foot pain and heel pain secondary to pes planus foot type.

The Board directs 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 each foot separately at 10%, moderate, for a combined disability rating of 20%. The VA applied VASRD code 5276 (acquired flatfoot) and rated it 10% for bilateral moderate pes planus. The VASRD does not have a separate code for plantar fasciitis (the predominant diagnosis in this

case) therefore, analogous coding was necessary. With regard to the 5310 muscle code, the Board noted that there was no disorder of the muscles of the feet present; however, the 5310 code includes “other important plantar structures: plantar aponeurosis, long plantar and calcaneo‐navicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes.” The ratings under this code apply separately to each foot and are based on a judgment of severity (slight 0%; moderate 10%; moderately severe 20%; and severe 30%). The Board adjudged this level of disability as moderate (as did the PEB and VA), exceeding mild because the pain did not respond to treatment and did not rise to moderately severe or severe as the pain did not prevent the CI from performing her daily activities. The Board also considered alternative coding and rating options that have been utilized for plantar fasciitis, specifically VASRD codes 5020 (synovitis). The VASRD code 5020 refers to the use of code 5003 (degenerative arthritis) for rating purposes. Under 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 for each foot. The Board recognized that rating under either of the alternative coding/rating schemes considered results in a combined 20% evaluation and would not confer any benefit to the CI. After due deliberation, considering all of 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 chronic foot pain and heel pain 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 chronic foot pain and heel pain condition 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 re‐characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131020, 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 20 Jan 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, XXX XX XXXX, former USN
-	XXXXXXXXXXXXXXX, XXX XX XXXX, former USMC
-	XXXXXXXXXXXXXXX, XXX XX XXXX, former USN
-	XXXXXXXXXXXXXXX, XXX XX XXXX, former USMC
-	XXXXXXXXXXXXXXX, XXX XX XXXX, former USN
-	XXXXXXXXXXXXXXX, XXX XX XXXX, former USN