RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00634
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Joint Tactical Information Distribution System Shipboard Terminal Maintenance Technician, medically separated for “chronic plantar fasciitis with heel spur formation” 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 - 20040428	VARD - 20050708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Plantar Fasciitis with Heel Spur Formation	5399-5310	10%	Left Plantar Fasciitis/Pes Cavum With Plantar Calcaneal Spurs	5276	10%	20050330	
			Left Plantar Fasciitis/Pes Cavum With Plantar Calcaneal Spurs	5276	10%	20050330	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Plantar Fasciitis (PF) with Heel Spur Formation.  Although the PEB did not cite a bilateral condition, it is inferred that the PEB combined the right and left foot conditions under a single disability rating, coded analogously to 5310 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 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.  The evidence for the right and left foot conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s PF began in 1999 with longstanding pain without specific injury.  He was placed on limited duty for 8 months in December 2003.  X-rays showed heel spurs.  There was no surgical indication.  

The 8 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of mild pain to palpation with no relief.  Night splints, custom orthotics and heel cushions did not help and the CI could not return to full duty due to the discomfort.  Physical examination showed pain to palpation to the plantar medial tubercle of both calcanei (bottom middle portion in the area of the heel). 

At the 11 June 2004 VA Compensation and Pension (C&P) evaluation, 15 days before separation, the CI reported stiffness, soreness and tenderness in his feet with sitting, standing, walking or running.  He did not require corrective shoes or devices and did not claim any time lost from work.  Physical examination of the feet showed no signs of abnormal weight bearing and no joints were involved.  There was mild tenderness throughout the plantar aspect of both feet, but no pes planus, hammertoes, hallux valgus or hallux rigidis.  

The 30 March 2005 C&P evaluation, 9 months after separation, showed X-ray findings of moderate bilateral plantar calcaneal spurs.  The CI reported increased foot pain with activity and occasionally used shoe inserts.  Pain occurred after prolonged standing.  Physical examination showed a normal gait with no braces or other supports used.  Shoe wear was normal and there was no evidence of callous formation or pressure sores.  The plantar surface was tender.

The panel considered if the right and left PF conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, both feet were implicated by the NARSUM and the Limited Duty (LIMDU) MEB report.  Review of STR evidence showed that all of the visits were for bilateral foot pain.  Since undue speculation would be required to conclude that impairment from either would not have unacceptably interfered with duty performance, members agreed that each foot was reasonably justified as separately unfitting.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral PF condition 10%, coded analogously as 5399‑5310 (foot and leg Group X Function).  The VA rated the left and right PF conditions 10% each foot, coded 5276, (acquired flatfoot), based on the C&P examination 9 months after separation, citing review of the claims file and X-ray evidence of bilateral heel spurs.

The panel noted there was no evidence of acquired flat foot (5276), claw foot (5278), or severe hallux valgus (5280) in either foot to justify a rating under the respective codes.  There was no evidence of hammertoes (5282), fractures with mal union or nonunion (5283) or injuries to either foot that would be characterized as moderate (5284) to validate ratings under those codes.  There was no evidence of metatarsalgia to substantiate a 10% rating using code 5279 which specifies unilateral or bilateral.  The NARSUM noted X-ray evidence of bilateral heel spurs and the LIMDU cited duty restrictions of 8 months related to bilateral PF.  Panel members agreed the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties, and accordingly a separate disability rating is recommended.  After due deliberation, and considering all of the evidence, the panel recommends a disability rating of 10% for the right foot condition and 10% for the left foot condition, each coded 5399-5310.

BOARD FINDINGS:  In the matter of the right and left foot conditions, the panel unanimously recommends a separate disability rating of 10% each, coded 5399-5310 IAW VASRD §4.73.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Plantar Fasciitis with Heel Spur Formation	5399-5310	10%	
Left Plantar Fasciitis with Heel Spur Formation	5399-5310	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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 XXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 06 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 06 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 07 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 08 Mar 18 ICO XXXXXXXXXXXXXXXXXX

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

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

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

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 10 percent) effective date of discharge.       

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

     f. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent rating (increased from 10 percent) effective date of discharge.  

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

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.
	
     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                                  	XXXXXXXXXXXXXXXXXX
                                 	Acting