RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00096
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, P-3 Systems Organizational Apprentice Maintenance Technician, medically separated for “bilateral plantar fasciitis” with a disability rating of 0%.

CI CONTENTION:  Please consider all conditions.  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 – 20060203	VARD – 20061117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	0%	Plantar Fasciitis, Right Foot	5278	10%	20060815	
			Plantar Fasciitis with Plantar Heel Spur, Left Foot 	5284	10%	20060815	
History of Left Calcaneal Stress Fracture	Cat II					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot pain begun in September 2003.  The CI was diagnosed with a left calcaneal fracture and treated with a short leg cast.  The CI continued to report left foot pain with running and prolonged standing.  A July 2004 primary care note documented reports of bilateral foot pain.  A podiatry evaluation dated 30 September 2004 documented reports of bilateral foot pain with running or walking greater than 30 minutes.  The physical examination showed tenderness to palpation from the heel to the arches of both feet.  The examiner rendered diagnoses of bilateral plantar fasciitis and Achilles tendinitis.  Orthotic inserts and anti-inflammatory medication were prescribed.  The MEB forwarded “unspecified fasciitis” for PEB adjudication.

At a physical therapy evaluation dated 3 January 2005 the CI reported bilateral foot pain with use.  On examination there was an antalgic gait, decreased stance time left greater than right and tenderness to palpation entire plantar surface of both feet.  The MEB NARSUM examination on 16 November 2005, 6 months prior to separation, noted complaints of bilateral foot pain.  Physical examination showed exquisite tenderness to palpation at the origin of the plantar fascia bilaterally and normal ambulation with a cane.  There was no ankle limitation of motion; painful motion was not addressed.

At the 15 August 2006 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported daily foot pain with physical activity.  The CI reported using orthotics and a cane for long walks.  Physical examination showed normal gait and ankle range of motion.  There was pain with plantar flexion and tenderness to palpation of both feet.  Radiographic evaluations demonstrated a left heel spur.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis 0%, coded 5399-5310 (muscle group X…plantar), citing slight muscle impairment.  The also adjudicated the left calcaneal heel fracture as Category II, related to the unfitting plantar fasciitis.  The VA rated the right plantar fasciitis condition 10%, coded 5278 (claw foot (pes cavus), acquired), based on the VA C&P examination 3 months after separation, citing pain with repetitive motion.  The VA rated the left plantar fasciitis condition 10%, coded 5284 (foot injuries, other “moderate”) based on the VA C&P examination 3 months after separation, citing left foot tenderness with X-ray evidence of a plantar heel spur.

Although VASRD permits combined ratings, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 if the PEB combined adjudication is not VASRD compliant for combined rating criteria, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  In this case, a bilateral condition was profiled, considered to fail retention standards, and implicated by the MEB NARSUM.  Members agreed that each foot is separately unfitting and that identical coding and ratings are applicable.  The Board noted that at the examinations most proximate to separation demonstrated a normal gait, but required a cane for ambulation.  Board members agreed that the evidence supports a 10% rating for moderate muscle impairment secondary to pain analogous coded 5310 for muscle injury of the plantar aponeurosis.  The evidence did not support foot weakness resulting in an abnormal gait, muscle atrophy, or inability to ambulate for a moderately severe rating under 5310 or 5284.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board determined that each foot was unfitting and recommends a disability rating of 10% for the each foot condition, coded 5399-5310.

Contended PEB Conditions:  The Board’s main charge is to assess the fairness of the PEB’s determination that the left calcaneal fracture condition was related to the unfitting condition.  The contended condition was not profiled or judged to fail retention standards.  The Board noted the history of a left foot calcaneal fracture, however, there was no evidence of malunion or non-union.  The primary functional impairment was related to heel pain.  Board member agreed that the residual pain related to the left heel fracture could not be rated separately IAW §4.14 (avoidance of pyramiding); therefore there was insufficient cause to recommend a change in the PEB adjudication as a Category II condition.

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis condition, the Board unanimously recommends a disability rating of 10% for each foot, coded 5399-5310 IAW VASRD §4.73.  In the matter of the contended left calcaneal fracture conditions, the Board unanimously recommends no change from the PEB determination as related to the Category I condition.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Foot Plantar Fasciitis	5399-5310	10%	
Left Foot Plantar Fasciitis	5399-5310	10%	
COMBINED w BLF	20%	

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 COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (l) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     j. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     k. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
						      (Manpower & Reserve Affairs)