DEPARTMENT   OF   THE NAVY
SECRETARY  OF THE  NAVY COUNCIL  OF REVIEW BOARDS
720 KENNON STREET SE STE 309 WASHINGTON  NAVY  YARD,   DC  20374

IN  PHLY   PEITR T•):
1850
CORB:003
27 Feb 20

From:	Director, Secretary of the Navy Council of Review Boards To:	PD-2017-00714

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 4 Feb 19

1.	Pursuant to reference {a), the PDBR reviewed your case and forwarded   its
recommendation to the Department of the Navy for appropriate action.

2.	On 21 February 2020, the Assistant General Counsel of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs for appropriate changes to your personnel records and notification to you upon completion.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00714 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080531

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fixed Wing Aircraft Power Plants Mechanic, medically separated for “chronic recalcitrant bilateral plantar fasciitis and pes planus” with a disability rating of 10%.

CI CONTENTION: “The rating only accounted for one portion, Plantar Fasciitis. It did not account for my hips and back which have greatly affected me since 2006.” 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20080228	VARD - 20081105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Recalcitrant Plantar Fasciitis Bilaterally and Pes Planus	5399-5310	10%	Bilateral Pes Planus and Plantar Fasciitis Status Post Surgery with Chronic Pain and Residual Scars	5284-5276	30%	20080822	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	
	
ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis and Pes Planus. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral plantar fasciitis (inflammation of a thick band of tissue that connects the heel bone to the toes) began in September  2005.    Conservative  care  was  not  beneficial  and  a  bilateral  endoscopic plantar

fasciotomy was performed in April 2007. Despite surgery, physical therapy (PT) and orthotics, bilateral foot pain did not subside.

The 29 January 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of bilateral foot pain and stiffness in the morning and pain while running. Physical examination showed bilateral pes planus (flat feet). Bilateral ankle dorsiflexion was normal bilateral heels were tender, and arches supple. The MEB NARSUM examiner’s recommendation was that recalcitrant plantar fasciitis and pes planus bilaterally precluded the CI’s continuation on active duty. The non-medical assessment dated 13 February 2008 noted the CI was unable to participate in any high impact activity, despite bilateral orthotics, corrective shoes, PT, and surgery.

At the 22 August 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported bilateral plantar fasciitis with daily symptoms and weekly flares and the use of orthotics and corrective shoes. Physical examination showed a normal gait and no foot effusion. Bilateral feet showed great toe and heel calluses and flatfeet with weight bearing over or medial to the great toe. There was pain at rest and with manipulation. Malalignment was correctable with manipulation.  Foot swelling was not addressed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral foot condition 10%, analogously coded 5399-5310 (muscle group X injury, includes plantar fascia). The VA rated the bilateral foot condition 30%, dual-coded 5284-5276 (foot injuries, other – flatfoot, acquired), based on the C&P examination, citing the condition more nearly approximated the 30% evaluation for pronation, pain during rest and manipulation, and no arch noted.

The panel first considered if both foot 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 NMA and MEB NARSUM. The panel concluded there was not a preponderance of evidence in the service records which overcame the panel’s presumption that each foot condition was reasonably considered separately unfitting. The panel then considered its rating recommendation for the unfitting foot conditions at the time of separation.

The panel agreed that there was evidence to support a 10% rating for each foot under analogous coding of 5399-5310 for a “moderate” muscle injury with pain at rest and manipulation of each foot. A “moderately severe” impairment was not supported due to a normal gait and correctable bilateral foot malalignment with manipulations as recorded on the VA examination. A rating under code 5276 (flatfoot, acquired) was also considered. The panel arrived at a “moderate” bilateral impairment to support a bilateral 10% rating but no higher, based on the absence of marked foot deformity, no swelling with use, and a normal gait as recorded on the VA examination. The panel considered other foot and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher than a 10% rating supported for each foot. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left foot condition and 10% for the right foot condition, both coded 5399-5310.

BOARD FINDINGS: In the matter of the bilateral plantar fasciitis and pes planus conditions, the panel recommends each joint be separately adjudicated as follows: an unfitting right plantar fasciitis and pes planus condition and an unfitting left plantar fasciitis and pes planus condition, each rated 10%, and both coded 5399-5310 IAW VASRD §4.73. 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Plantar Fasciitis and Pes Planus	5399-5310	10%	
Left Plantar Fasciitis and Pes Planus	5399-5310	10%	
	COMBINED	20%