RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00507
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE: 20030210 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Supply Administration and Operations Clerk, medically separated for “right central heel pain…” rated 10%.  

CI CONTENTION:  “Received 0% Service Connected but this condition stopped me from continuing my military career (planned on retiring).”  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 on 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 - 20021115	VARD - 20030505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Central Heel Pain…	5399-5310	10%	Residuals of Plantar Fasciotomy…	5310	0%	20030423	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Central Heel Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right heel pain condition began in September 2001 after running and prolonged weight bearing.  On examination there was tenderness on the plantar surface of the calcaneus (heel bone) and a slight gait disturbance. X-rays in September 2001 showed no significant abnormalities.  Plantar fasciitis was diagnosed and insoles were dispensed along with Naprosyn (naproxen, a nonsteroidal anti-inflammatory drug (NSAID).  Physical therapy treatment consisting of iontophoresis, ultrasound, cross fiber massage, and a night splint afforded a moderate benefit. At an orthopedic evaluation in December 2001 the CI had a full range of motion (ROM) of the left ankle/foot and was given a steroid injection for the right plantar fasciitis.  While playing basketball in January 2002, he felt a pop on the boot of his right foot, which was treated with Motrin (ibuprofen, an NSAID).  Podiatric evaluation in February 2002 noted that a lateral X-ray of the right foot demonstrated a small amount of plantar and posterior calcaneal spurring, although those were not the areas where the CI had pain. Conservative therapy did not provide significant relief and on 7 March 2002 the CI underwent an open right plantar fascia release (plantar fasciotomy).  Despite treatment, the right heel pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “right central heel pain chronic” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 2 May 2002, 9 months prior to separation, the CI reported surgery on the right foot “to remove part of the plantar fasciitis muscle” and noted numbness and tingling in the area.  The physical examination revealed a plantar surgery scar.  Subsequently, he had two corticosteroid injections in the right heel in July 2002 and was prescribed Vioxx (rofecoxib, an NSAID), which provided near complete relief for approximately 1-2 days. However, he was unable to run or perform weight-bearing activities due to pain.  The MEB NARSUM examination on 29 August 2002, 6 months prior to separation, the CI had normal alignment of his hindfoot, midfoot, and forefoot.  The operative scar was well healed and nontender and the plantar fascia origin was nontender, although he did have some pain with stretching of the plantar fascia in the region of the scar; however, he had tenderness to palpation of the central portion of his heel on the plantar aspect of the foot.  He had no significant Achilles tendon tightness or contracture and was neurovascularly intact distally.  

At the 23 April 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported he still had “some aching in his right foot” around the heel with a level of pain of 4/10 (10 being the worst pain), which was aggravated by being on it for very long (greater than 4-5 hours).  On examination there was a small scar about the right heel, which was very well healed, but hard to see.  There were no visible deformities of the right foot or the right heel or signs of plantar fascial tenderness.  There was no claw toe or hammertoe deformity.  The arches were not high or fallen and the Achilles tendon was not tender.  There were no significant callouses.  He had no loss of motion of the foot or toes and his gait was normal.  An X-ray showed a small plantar calcaneal spur.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right central heel pain, chronic, status post plantar fascia release, without relief condition 10%, coded 5399-5310 (Group X. Function:  Movements of forefoot and toes; propulsion thrust in walking.  Other important plantar structures:  Plantar aponeurosis-moderate), citing heel pain.  The VA rated the right heel pain condition 0% coded 5310, based on the VA C&P examination 2 months after separation, citing residuals of plantar fasciotomy, right foot with calcaneal spur-slight muscle disability.  Board members considered whether the condition warranted a 20% rating using code 5310 or code 5284 (foot injuries, other) ; however, at the time of separation, the condition was not moderately severe since the CI did have some pain with stretching of the plantar fascia in the region of the scar at the NARSUM examination, but by the time of the VA examination, which was more proximate to separation, there were no signs of plantar fascial tenderness and there was no loss of motion in the foot or toes.  Therefore, there was no route to a higher rating.  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 right central heel pain condition.  

BOARD FINDINGS:  In the matter of the right central heel pain condition and IAW VASRD §4.71a, 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 20150529, 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 15 Nov 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)