RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01458
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20070815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Administrative Clerk, medically separated for “chronic bilateral plantar fasciitis” 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 condition 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 - 20070612	VARD - 20071017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Plantar Fasciitis	5399-5310	10%	Bilateral Plantar Fasciitis	7805-5276	0%	20071009	
Postoperative Adhesions, Left Foot	Cat II	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Bilateral Plantar Fasciitis.  The PEB combined the bilateral plantar fasciitis condition under a single disability rating, coded 5399-5310 (moderate muscle injury Group X).  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 plantar fasciitis condition began in 2004.  

During the 13 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported bilateral foot surgery with “serious problems” with the left foot.  The examiner noted an inability to stand greater the 15 minutes because of pain and numbness in both feet.  Physical examination showed well healed scars on both feet with decreased dorsiflexion of the left foot because of CAM walker.  

The 27 December 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of discomfort with weight bearing and pain aggravation with impact activities.  Physical examination showed an antalgic gait, tenderness over the surgical site of the left foot and mild left heel edema (swelling).  There was no ankle or subtalar joint limitation of motion.  

The 29 May 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of sharp, stabbing left heel pain.  The pain was constant with walking.  He denied right heel pain.    He reported continued use of a CAM walker.  Physical examination showed normal foot alignment with weight bearing.  There was mild discomfort over the right heel scar and no significant tenderness to palpation elsewhere.  The left foot was tender to palpation over the posterior tibial nerve, heel scar, and direct plantar surface.  Range of motion for the left ankle was normal.  

At the 9 October 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported improvement in his left foot pain.  He reported continued use of the shoe inserts. He reported the ability to walk for up to 1 hour and stand for 20 minutes.  Physical examination showed non-tender scars bilateral heels, a normal gait, and full range of motion of the ankles and feet.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral plantar fasciitis condition 10%, coded 5399-5310 (moderate muscle injury Group X).  The PEB adjudicated the left foot postoperative adhesions condition as a Category 2 condition, related to the unfitting condition.  The panel concluded the Category II diagnosis (left foot postoperative adhesions) was not a separate condition which could be reasonably justified as separately unfitting; nor would a separate rating be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The VA rated the bilateral plantar fasciitis condition 0%, coded 7805-5276, (scars other-acquired flatfoot), citing mild symptoms relieved by built-up shoe or arch support.  

The panel first considered if the plantar fasciitis condition met the panel’s threshold for separate rating for each foot (as elaborated above).  The panel noted that at the time of the May 2007 NARSUM the CI reported left foot pain, but denied complaints for the right foot.  The panel also noted that the preponderance of treatment records for 1 year prior to separation addressed left foot pain.  Panel members agreed that the left foot could be reasonably justified as separately unfitting.  The panel members concluded that the preponderance of evidence showed the right foot plantar fasciitis condition would not have caused the CI to be referred into the DES or found unfit.  

The panel then considered a rating recommendation for the left foot condition.  There was no evidence of moderately severe foot muscle dysfunction or foot injury for ae 20% rating under VASRD code 5310 and 5284 (foot injuries). Panel members agreed that the evidence supports a 10% rating for metatarsalgia (foot pain) or analogous to moderate muscle dysfunction under 5279 and 5399-5310, respectively.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral plantar fasciitis condition.  

BOARD FINDINGS:  In the matter of the bilateral plantar fasciitis and post-operative left foot adhesion conditions and IAW VASRD §4.73, the panel unanimously recommends no change in the PEB adjudications.  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 20150602, 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
						XXXXXXXXXXXXXXXXXX