RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02440
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20090227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Data Network Specialist, medically separated for “plantar fasciitis, left foot” 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 - 20081125	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Plantar Fasciitis, Left Foot	5399-5310	10%	No VA Placement	
Pes Planus, Both Feet	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Plantar Fasciitis, Left Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot pain began in January 2007 with no record of injury or trauma.  It was aggravated by running and relieved by rest, heat, and removing his shoes.  He was treated for plantar fasciitis with medications, inserts, physical therapy, and limited duty.  Excessive pronation (inward foot roll) of both feet was noted by podiatry, but a 12 March 2007 MRI of the left foot was unremarkable.  A steroidal injection provided about 6 months of pain relief before it recurred.  Although the CI benefitted from treatment, he was not able to run or return to full duty.

The 25 August 2008 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of ongoing left foot pain with pronation contributing to the pain.  Physical examination showed bilateral pronation and flat feet (documented in the service entry physical).  The left foot was tender along the plantar fascia with decreased range of motion.  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 left plantar fasciitis condition 10%, analogously coded 5399-5310 (Group X muscle injury).  The bilateral pes planus (flat feet) was listed as a Category II condition (related and contributes to the unfitting condition).  The panel first considered whether the bilateral pes planus was separately unfitting.  The STR, NARSUM and non-medical assessment consistently documented the left foot as symptomatic, but not the right, and so members agreed the evidence reasonably justifies the left foot, and not the right, as separately unfitting.  However, because the left pes planus symptoms are not distinguishable from the plantar fasciitis symptoms, a separate left foot rating is not permissible IAW VASRD §4.114 (avoidance of pyramiding).  The panel further noted documentation of left foot pronation and that the CI only had partial benefit from treatment.  Left foot pain with manipulation was present, swelling was absent, and the presence of callosities was not addressed.  The panel considered whether the description for a severe or moderate level disability better fit the level of impairment in evidence.  Members agreed that the CI’s condition most approximated a severe pronation, supporting a 20% rating using the code 5276 (flatfoot).  While a 20% rating (moderately-severe) was also supported using code 5310, the panel determined code 5276 better described the CI’s condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the plantar fasciitis, left foot condition, coded 5276.

BOARD FINDINGS:  In the matter of the plantar fasciitis, left foot condition, the panel unanimously recommends a disability rating of 20%, coded 5276 IAW VASRD §4.71a.  In the matter of the Category II bilateral pes planus condition, the panel unanimously agrees it cannot be recommended for additional service disability rating.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends 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 Foot	5276	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated “2015”, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 13 Oct 17 ICO XXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 28 Sep 17 ICO XXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 11 Apr 17 ICO XXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 16 Jun 17 ICO XXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 25 Sep 17 ICO XXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 20 Sep 17 ICO XXXXXXXXXXXXXXXXXXX 

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

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

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

     c. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXX, former USN: Placement on Temporary Disability Retired List with a 60 percent disability rating for six months at time of separation followed by a permanent disability rating of 20 percent.

     f. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on Temporary Disability Retired List with a 50 percent disability rating for six months at time of separation followed by a permanent disability rating of 10 percent.

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     h. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

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