RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00428
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141010
SEPARATION DATE:  20070514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (MA2/Master-at-Arms) medically separated for a bilateral foot condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  Plantar fascial fibromatrosis was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic plantar fasciitis bilaterally as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 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.  Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20070129	VA* - (2.5 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Plantar Fasciitis Bilaterally	5399-5310	10%	Right, Foot Plantar Fasciitis	5009-5020	10%	20070226	
			Left, Foot Plantar Fasciitis	5009-5020	10%	20070226	
Other x 0 (Not in Scope)	Other x 6 (Not in Scope)	
Rating:  10%	Combined:  60%	
*Derived from VA Rating Decision (VARD) dated 20070724 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Chronic Bilateral Plantar Fasciitis.  Specific records pertaining to the CI’s foot condition span from June 2003 to December 2006.  The CI first experienced right-sided heel and foot pain in June 2003 without history of direct trauma.  All but two source documents contained in the service treatment record presented with right foot complaints and pathology.  The first document depicting a bilateral condition was in April 2006 and both encounters indicated the right foot was more impaired than the left.  Under the care of podiatry, the CI’s non-surgical conservative treatments did not relieve his painful symptoms and he was referred for an MEB.  At the MEB narrative summary examination (5 months prior to separation) the CI reported a chronic dull to sharp pain about both heels that was aggravated with prolonged standing and running and minimally relieved with rest.  The physical examination (PE) was brief and revealed a normal gait and normal arches of his feet.  There was tenderness over both heels and along the inside portion of the arch both findings were right greater than left.  There was no comment on range of motion (ROM) or painful motion of the feet.  X-rays revealed the presence of bilateral heel spurs.  The diagnosis was chronic bilateral plantar fasciitis.  The examiner noted, “He is unable to do his prescribed job.”  The commander’s non-medical assessment clearly indicated the recommendation that the CI be found unfit for duty due to his physical restrictions and inability to perform all the duties required by his military rating.

At the VA Compensation and Pension examination, performed on 26 February 2007 (2.5 months prior to separation), the CI reported bilateral heel pain associated with swelling, warmth, redness and fatigability; all worsened with prolonged standing.  Additionally, he endorsed right-sided flare-ups occurring three times a week up to 2-hour duration.  He denied left-sided exacerbations.  The PE noted a normal gait without painful motion, instability, or weakness.  There was tenderness to both heels and mid-foot without abnormal alignment.

The Board directed its attention to rating recommendations for the bilateral foot condition and debated several options for coding and rating.  The VASRD does not have a specific code for plantar fasciitis and it must be rated analogously.  The PEB and VA chose different coding options for the condition and both were IAW §4.73 and §4.71a, respectively.  The PEB chose to bundle the feet and assign an analogous muscle code 5399-5310 (Group X) at 10% (moderate).  The original VARDs chose to separately rate and assign 10% to each foot with the analogous code of 5099-5020 (synovitis), citing painful plantar fascia.  With regard to the 5310 muscle code indicated by the PEB, 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 ligament, etc…” and therefore, the selection of this code by the PEB is reasonable when applied unilaterally; however, its application in this case did not entail separate ratings.  The separate ratings under this code are based on a judgment of severity (slight 0%; moderate 10%; moderately severe 20%; and severe 30%).

The Board first considered whether each foot condition remained separately unfitting, having decoupled them from the combined PEB adjudication.  The evidence clearly established that the right foot was more impaired than the left foot.  The disparity was such that the question was raised of whether the left foot was reasonably justified as separately unfitting.

Although the right foot was noted to be the more symptomatic; the foot conditions were linked by common pathology and diagnosis, bilateral designations on all of the medical assessments, combined on LIMDU status, and jointly failed retention standards.  The members agreed, therefore, that attempting to separate out the left foot as not unfitting was overly speculative and arbitrary.  The Board agreed that equivalent coding was in order for separate ratings and deliberated appropriate coding options.  Members considered other separate analogous coding schemes and concluded that the 5310 muscle code was the best fit given the pathology present and being the more conventional choice for this condition.  Since the specific criteria of VASRD §4.56 for muscle injuries are not very practical for rating under this analogous use of the code, the Board relied on its judgment for more subjective assignment of the rated severity.  All members agreed that “moderately severe…20%” or “severe…30%” characterizations were not supported by the evidence.  Deliberations ensued as to rating the feet as 10% each under this code, or rating right 10% and left 0%.  At the conclusion of deliberations, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right foot and 0% for the left foot.

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 plantar fasciitis condition and IAW VASRD §4.73, the Board unanimously recommends that each joint be separately rated as follows:  an unfitting right foot condition, coded 5399-5310 and rated 10%, and an unfitting left foot condition, coded 5399-5310 and rated 0%.  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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Plantar Fasciitis, Right  Foot  	5399-5310	10%	
Plantar Fasciitis, Left Foot 	5399-5310	0%	
COMBINED (Incorporating BLF)	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140113, 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 8 Apr 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:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN