RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01776
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20091117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Information Technician, medically separated for “bilateral plantar fasciitis” 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 - 20091020	VARD - 20091223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	10%	Plantar Fasciitis, Bilateral	5099-5020	NSC	STR	
Bilateral Transfer Metatarsalgia…	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Plantar Fasciitis.  The PEB combined the left and right plantar fasciitis conditions under a single disability rating, coded 5399-5310 (analogous to Group X muscle impairment which includes the plantar fascia).  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, they 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 first record of the CI’s foot condition was a 19 June 2007 VA physical documenting her account of a 1-year history of right greater than left foot pain without antecedent trauma.  She stated she had received care from a non-physician provider while deployed and was given medications and 3 weeks of limited duty; right ankle X-rays at that time reportedly did not show spurs (a sign of plantar fasciitis). The examiner prescribed gel inserts and requested X-rays which showed no acute fractures or dislocations, no degenerative changes and unremarkable soft tissue structures.  At a 2 November 2007 podiatry consultation, the CI had pain upon palpation of both heels, with the right worse than left.  There was excessive flattening of medial arches present during gait analysis but no signs of edema or ecchymosis.  The CI was then given steroid injections, and upon follow-up on 7 December 2007, she reported significant improvement.  The examiner diagnosed bilateral plantar fasciitis and ordered orthotics.   During a 24 January 2008 podiatry visit, the CI reported worsening symptoms and that she had not yet received the orthotics.  The record was then silent until she entered the MEB process.  

During the 22 February and 25 April 2009 MEB examinations (recorded on DD Forms 2807-1 and 2808), 9 and 7 months prior to separation, the CI did not report problems with her feet, and the examiner merely recorded bilateral plantar fasciitis.  The 14 June 2009 non-medical assessment noted the CI worked within her rating and did not miss duty from her condition.  Additionally she was considered a superb sailor and highly recommended for retention.
 
The 23 June 2009 MEB NARSUM examination, 5 months before separation, noted CI complaints of ongoing bilateral foot pain interfering with both her military duties and civilian occupation (bus driver).  Her gait was mildly antalgic (abnormal due to pain) and favored the left foot, and she was limited to soft-heeled shoes.  There were signs of a high arch (peekaboo heel) and inward rotation (heel varus), left greater than right.  She was tender under the balls of the 2nd and 3rd toes, right great than left, as well as the heels, left greater than right.  X-rays confirmed the presence of the varus and further treatment was recommended as well as a 6-month period of limited duty.  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 plantar fasciitis condition 10%, analogously coded 5399-5310, citing “left greater than right.”  The PEB also listed bilateral transfer metatarsalgia as a related Category II (contributes to the primary unfitting condition but not separately ratable) condition. Transfer metatarsalgia is pain in the forefoot due to pathology elsewhere (in this case the plantar fasciitis).  The VA determined the bilateral plantar fasciitis condition was not service-connected, and analogously coded 5099-5020 (synovitis), based on the STR. Members first agreed that the impairment from the bilateral transfer metatarsalgia was properly subsumed under the overall rating for the bilateral plantar fasciitis IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  Next, the panel agreed that the evidence established that both feet impaired duty and were reasonably justified as separately unfitting at separation.  Members noted that the CI had an abnormal gait and favored the left side at the NARSUM examination.  However, the commander highly recommended retention and stated that she met the requirements of her rating without missing work from her condition.  Members agreed that while the totality of evidence supported findings for a moderately impaired left foot and slightly impaired right foot, with 10% and 0% ratings respectively, this afforded no benefit to the CI.  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 condition and IAW VASRD §4.73, 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 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 20150630, 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

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

		
							XXXXXXXXXXXXXXXXXXX
	     				Principal Deputy, Assistant 
						Secretary of the Navy
						(Manpower and Reserve Affairs)
						Performing the Duties of the 
						Assistant Secretary of the Navy
						              (Manpower and Reserve Affairs)