RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00694
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20090530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Personnel Clerk, medically separated for “recalcitrant plantar fasciitis bilateral” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20090324	VARD - 20090908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recalcitrant Plantar Fasciitis Bilateral	5399-5310	10%	Chronic Bilateral Pes Cavus	5278	0%	20090324	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Recalcitrant Plantar Fasciitis Bilateral.  The PEB combined the left foot and right foot conditions under a single disability rating, coded analogously to 5399-5310 (muscle group X) and rated 10%.  This 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 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.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral foot condition began in September 2005 with onset of bilateral lower leg, ankle, heel, and foot arch pain following heavy training.  Despite treatments including custom orthotics, multiple periods of limited duty, and partial plantar fascial releases in November/December 2007, bilateral foot pain recurred following return to activities.  

The 13 February 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of recurrence of significant discomfort in arches of both feet and lower legs upon return to full duty involving running, and impact activities; with Inability to run or be involved in impact activities without significant discomfort.  Weightbearing X-rays showed bilateral increased arch height consistent with bilateral pes cavus.  Physical examination showed a mechanical examination consistent with pes cavus bilaterally.  Foot motion was essentially normal and there was no swelling or redness to the feet.  There was bilateral tenderness to the heels and plantar fascia bilaterally.  There was reducible mild flexion contracture for the toes excluding the great toe (1st).  There was no motor, vascular, or sensory deficits.  

At the 24 March 2009 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported pain in the middle third of the arch of both feet after waking 10-12 miles with a heavy load or running longer distances.  Physical examination showed bilateral mild to moderate cavus high arch and mild forefoot varus (angulation).  There was normal range of motion of both feet and ankles.  Muscle strength was normal and there was no localized pain to deep palpation.  The examiner indicated DeLuca requirements of mild to moderate feet pain, weakness, and lack of endurance after longer running or walking with a heavy load.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the PEB combined the left foot and right foot conditions under a single disability rating, coded analogously to 5399-5310 (muscle group X) and rated 10%.  The VA rated the bilateral foot condition 0%, coded 5278 (claw foot [pes cavus], acquired), based on the C&P examination 2 months before separation, citing only slight symptoms of claw foot.  

Panel members agreed the evidence reasonably justified that the functional limitations of each foot condition contributed to the CI’s inability to perform his military duties, and accordingly a separate disability rating could be considered for each foot.  

Code 5310 ratings, IAW VASRD §4.73 (muscle injuries), are applicable for each side.  However, neither the right foot nor the left foot rose to the level of a “moderate” (10%) muscle injury IAW VASRD §4.55 and §4.56.  The panel considered alternative rating under VASRD §4.71a and codes 5278 as well as 5020 (synovitis).  Rating under code 5278 is for the unilateral or bilateral condition; however there was no marked contraction or deformity, no ankle limitation, and no marked tenderness for any rating higher than 10%.  For alternative rating under code 5020, there was no X-ray evidence of arthritis or satisfactory evidence of pain-limited motion for any rating higher than the 10% awarded by the PEB.  

After due deliberation, and considering all of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bundled bilateral foot condition.  

BOARD FINDINGS:  In the matter of the bilateral foot condition and IAW VASRD §4.73 and §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/attachments
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

      In accordance with reference (a), I have reviewed the cases listed below and 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 USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting