RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03819
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Field Corpsman, medically separated for “plantar fasciitis,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Chronic pain from plantar fasciitis and recurring flare-ups of my skin condition.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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:  

SERVICE PEB - 20021113	VARD - 20030708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Symptomatic Plantar Fasciitis
(10% Right + 10% Left w/ BLF)	5399-5310	20%	Plantar Fasciitis with Achilles Tendonitis, Left Foot 	5284	10%	20021218	
Tight Gastroc Muscles	Cat II	Plantar Fasciitis with Achilles Tendonitis, Right Foot	5284	10%		
Congenital Pes Planus						
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Symptomatic Plantar Fasciitis.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an onset of bilateral foot pain with prolonged ambulation during the CI’s hospital corpsman training (2 years before separation).  He was diagnosed with plantar fasciitis and treated with orthotics.  Foot X-rays were normal.  There was no STR evidence of gait disturbance or other significant functional limitations.  There was STR evidence of modest (~25%) reduction in ankle dorsiflexion, but range of motion (ROM) was otherwise noted as grossly normal.  Surgery was not indicated; a protracted trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “congenital pes planus,” “symptomatic plantar fasciitis,” and “tight gastroc muscles” to the PEB.  

The podiatry NARSUM examination in September 2002 (5 months before separation) documented chronic bilateral foot pain without elaboration of severity or functional limitations.  The physical examination recorded “a moderately pes planus foot” and bilateral arch tenderness without other positive findings (no comment regarding gait).  The only ROM evidence was “less than 15 degrees (normal 20) of foot dorsiflexion at the ankle bilaterally.”

A VA Compensation and Pension (C&P) examination in December 2002 (2 months before separation) documented foot pain rated 8/10 at its worst in the morning and improving over the day.  The physical examination recorded tenderness over the Achilles tendons “right worse than left” and “slight pronation” without other positive findings (no comment regarding gait).  Measured ankle ROM was dorsiflexion of 0 degrees on the right and 5 degrees on the left, and bilateral plantar flexion of 35 degrees (normal 45).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded each foot analogously to 5310, the muscle disability code for Group X (movements of forefoot and toes); which is commonly applied and appropriate for plantar fasciitis.  The PEB’s 10% ratings were for “moderate” disability under 5310, which also offers 20% for “moderately severe” and 30% for “severe” disability.  The PEB adjudicated the above pes planus and tight gastrocnemius muscle diagnoses as Category II (contributes to the unfitting condition but is not separately ratable).  These conditions exacerbated (or caused) the plantar fasciitis; but, members agreed that neither one could be separately coded or rated without violation of VASRD §4.14 (avoidance of pyramiding), and thus were appropriately subsumed in the ratings for the unfitting plantar fasciitis.  The VA coded each foot 5284 (foot injuries, other), and its 10% ratings (based on the C&P evidence) were for “moderate” disability under the code; and, 5284 offers higher ratings for the same disability criteria as those above for 5310.  Both 5310 and 5284 are justified options, although 5310 is a better clinical fit, and neither is advantageous to rating.  The Board considered whether the higher 20% rating under either code, for moderately severe disability, could be reasonably supported.  Members agreed, however, that, especially applied as separate ratings, the disability in evidence (confined to prolonged ambulation or standing from an occupational standpoint), was best aligned with moderate disability.  The only other applicable and potentially advantageous VASRD code for consideration in this case was 5271 (ankle, limited motion).  A 20% rating under 5271 requires assessing ROM limitation as “marked,” however, and members agreed that the ROM limitation in evidence (conflicting for dorsiflexion and modestly limited plantar flexion) could not be reasonably characterized as marked.  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 of bilateral plantar fasciitis conditions.

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis 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.  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 20140714, 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 21 Sep 16

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