RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02098
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20091217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Navigation Equipment Maintenance Technician, medically separated for “[right] foot pain, soft tissue s/p plantar fascial release times 2” 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(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 - 20090824	VARD - 20100510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5399-5310	10%	Bilateral Plantar Fasciitis	5299-5276	0%	20100430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Foot Pain, Soft Tissue.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent successful surgery for plantar fasciitis of his left foot in 2006 (over 3 years before separation).  There was ample evidence that those symptoms responded well to surgery, and that the left foot was not incorporated with the MEB for the right foot.  He subsequently developed plantar fasciitis in the right foot and underwent surgery (fascial release) in March 2007.  This was not successful in relieving the pain, and a second fascial release was performed in February 2008.  Pain persisted after that procedure and a plantar neuroma was identified by imaging.  The CI underwent a surgical excision of the neuroma in April 2009 (8 months before separation).  Post-operative STR entries indicated that the neuroma pain was relieved by the surgery, but residual pain (primarily in the arch) prompted MEB proceedings.

STR entries after the last procedure documented the absence of malalignment or other foot deformity, normal ankle and foot strength (5/5), and a normal gait.  Ankle range of motion (ROM), 6 weeks after surgery, was dorsiflexion to 12 degrees (normal 20) and plantar flexion to 45 degrees (normal) with painful motion.  Ankle ROM was described as grossly normal by a subsequent examiner.  There was no documentation of any additional VASRD-ratable findings or alternate foot diagnosis (including pes planus) linked to a specific VASRD code.  The 9 July 2009 MEB NARSUM examination, 5 months prior to separation, documented the absence of left foot complaints and “unresolved” right foot pain without further elaboration, and did not specify functional limitations.  Physical examination recorded a “well-healed…extremely tender surgical excision of the right arch,” “intact” ROM, and 5/5 strength.

At the 30 April 2010 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI complained of nonspecific pain in both arches exacerbated by standing and walking.  The examiner documented the use of orthotics stating that there were no functional limitations with standing, walking, or activities of daily living.  Physical examination (all bilateral) recorded a normal gait, arch tenderness with no other positive findings, and 5/5 strength.  There was no documented ROM but painful motion was noted as absent.  The examiner specifically excluded the presence of pes planus and all other VASRD-coded foot diagnoses.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, analogously coded 5399-5310 (Group X muscle which encompasses forefoot and toe movement).  The PEB did not cite a rationale, but the 10% criterion of code 5310 is “moderate” disability analogous to plantar fasciitis.  Code 5310 offers ratings of 20% for “moderately severe” and 30% for “severe” disability.  The VA rated the bilateral foot condition 0%, analogously coded 5299-5276 (flatfoot [pes planus], acquired), based on the C&P examination 4 months after separation, citing failure to achieve the minimum 10% criteria of mild symptoms relieved by arch support.

The panel considered whether a higher rating was justified under the PEB’s code 5310, but members agreed that the functional disability in evidence (no impairment of gait or mobility, limitations confined to fairly strenuous activities) would not justify a rating higher than 10% under the above criteria.  Analogous rating under code 5284 (foot injuries, other) was likewise not favorable, offering an equivalent rating scale to that for 5310.  Members agreed that the VA’s code 5276 was dubiously applicable (the STR and C&P confirmed the absence of pes planus), and the 5276 criteria for ratings higher than 10% are quite specific and not supported by the evidence. Code 5271 (limited motion of the ankle), which requires “moderate” limitation for the minimum 10% rating, was not advantageous given the above ROM evidence; and, members agreed that no separately ratable impairment of the ankle and foot was discernable without violation of VASRD §4.14 (avoidance of pyramiding).  No other criterion was supported by the evidence that would justify a rating higher than the PEB’s 10% under any applicable code.  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 of the right foot condition.

BOARD FINDINGS:  In the matter of the right foot 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.  Therefore, the panel 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 20150722, 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:

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

		
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