RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00529
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Electronics Maintenance Marine, medically separated for “plantar fasciitis, bilaterally, chronic” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080320	VARD -NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis, Bilaterally, Chronic	5399-5310	10%	No VA Exam in Evidence	
Shin Splints Bilaterally	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Plantar Fasciitis, Bilaterally, Chronic.   The PEB combined the left foot plantar fasciitis and the right foot plantar fasciitis conditions as a single unfitting condition coded 5399-5310 and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral plantar fasciitis conditions are presented together.   

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral plantar fasciitis condition began in early 2007 during boot camp without any injury or trauma noted and worsened during Marine Corps training.   A note dated 21 May 2007 indicated the CI had bilateral foot pain with the right worse than the left for 2-3 months along with bilateral anterior lower leg pain.   Physical examination showed moderate arches bilaterally.  Both plantar heels were tender to palpation with pain to both plantar arch areas and the dorsal midfoot bilaterally.  Both feet had pain with horizontal squeezing of the metatarsals.  There was a full range of motion (ROM) of both feet and ankles.  Treatment consisted of naproxen (a nonsteroidal anti-inflammatory drug (NSAID)).  X-rays of the feet and the bilateral tibia/fibula dated 21 May 2007 were normal.  A bone scan on 22 June 2007 demonstrated findings likely consistent with shin splints of the lower extremities and stress fractures of the calcanei (heels) bilaterally and of the proximal fifth metatarsal of the right foot.  Inserts were dispensed and stretching exercises were discussed.  

On 28 2007 June minimal improvement was noted after 1 month of light/limited duty.  Some improvement was noted after 6 weeks of light/limited duty; however, despite improvement with the inserts, the CI developed pain at the bottom of the arches, along the Achilles tendon bilaterally as well as the front part of the legs.  The CI was referred to physical therapy, where band strengthening protocol for plantar fasciitis was carried out.  At a podiatry clinic visit on 8 November 2007 the CI stated he could no longer run despite custom orthotics.  In February 2008 the CI still complained of plantar fasciitis.  

During the 15 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bilateral plantar fasciitis and a history of bilateral calcaneal stress fractures and a right fifth metatarsal stress fracture.  The examiner noted bilateral plantar fasciitis and normal arches.  The 15 November 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of inability to stand for more than 10-to-15 minutes per hour and moderate-to-extreme pain upon running.  Physical examination showed tenderness upon palpation of the inferior aspect of the heels bilaterally, as well as tenderness on palpation of the central and medial bands of the plantar fascia laterally.  There was no edema, erythema (redness), calor (warmth), or ecchymosis (black and blue marks).  Neurologic examination was intact bilaterally. There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 10%, coded 5399-5310 (analogous to moderate Group X muscle injury).  The panel first considered whether right plantar fasciitis, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Panel members agreed that the evidence reasonably justified that the functional limitations of the right plantar fasciitis condition contributed to the CI’s inability to perform his military duties; and, accordingly a separate disability rating of 10%, coded 5399-5310 for moderate disability, based on bone scan changes, clinical findings, and inability to run, is recommended.  The panel then considered whether left plantar fasciitis, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Panel members agreed that the evidence reasonably justified that the functional limitations of the left plantar fasciitis condition contributed to the CI’s inability to perform his military duties; and, accordingly a separate disability rating of 10%, coded 5399-5310 for moderate disability, based on bone scan changes, clinical findings and inability to run, is recommended.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right plantar fasciitis condition, coded 5399-5310 and a disability rating of 10% for the left plantar fasciitis condition, coded 5399-5310.  

Contended Condition:  Bilateral Shin Splints:  The PEB listed the bilateral shin splints condition as a category II condition, a condition that is related to the primary unfitting condition and contributes to the primary unfitting condition.  The panel’s first charge for this Navy PEB Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  The panel’s threshold for such determinations is reasonably unfitting and remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The CI had anterior lower leg pain bilaterally; however, initial X-rays of the tibia and fibula bilaterally were normal, while a bone scan dated 22 June 2007 had findings likely consistent with shin splints of the lower extremities.  Clinically the CI had bilateral anterior lower leg pain with the right worse than the left.  However, after 8 weeks of light/limited duty the CI noted some improvement.   When running in August 2007 the CI noted pain along the bottom of the arches and pain along the Achilles tendon bilaterally as well as the front part of his legs.  However, while the CI had multiple physical therapy sessions for treatment of the plantar fasciitis, there was no mention of the bilateral shin splits nor was there a mention in any of the clinic visits thereafter.  Members agreed that the subsumed Category II bilateral shin splints condition was not reasonably justified as separately unfitting since the bone scan findings were likely consistent with rather than diagnostic of shin splints.  X-rays of the tibia and fibula bilaterally were negative, and the CI was placed on light duty for a reasonable period of time for healing to have begun and to have advanced to a level that by itself would not likely to be unfitting.  The panel members concluded that the bilateral shin splints condition alone was not unfitting.  

After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB determination for the Navy Category II bilateral shin splints condition; and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right plantar fasciitis condition, the panel unanimously recommends a disability rating of 10%, coded 5399-5310 IAW VASRD §4.71a.  In the matter of the left plantar fasciitis condition, the panel unanimously recommends a disability rating of 10%, coded 5399-5310 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

In the matter of the contended bilateral shin splints condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  

The panel 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	
Plantar Fasciitis, Left, Chronic	5399-5310	10%	
Plantar Fasciitis, Right, Chronic	5399-5310	10%	
COMBINED 	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record

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

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(c) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX
  
	(d) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(e) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(f) PDBR ltr dtd 07 Jul 17 XXXXXXXXXXXXXXXXXX

	(g) PDBR ltr dtd 02 Aug 17 XXXXXXXXXXXXXXXXXX

	(h) PDBR ltr dtd 06 Jul 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (h) are approved.  The official records of the following individuals are to be corrected as follows:

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

     b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 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 USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

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

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

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.       
     
3.  Please take action to implement these decisions.

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