RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03758 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Vehicle Operator, medically separated for “bilateral plantar fasciitis” with a disability rating of 10%.

CI CONTENTION: “…foot deformity has become more severe.” 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 – 20080226	VARD – 20080514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Plantar Fasciitis	5399-5310	10%	Bilateral Pes Planus	5276	0%	20080514	

Postsurgical Status Bilateral Bunion Correction	
Not Unfitting	Bunionectomy, Right First Metatarsal	5280	10%	20080514	
		Bunionectomy, Left First Metatarsal	5280	0%	20080514	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis. The PEB combined the bilateral plantar fasciitis under a single disability rating analogously coded 5399-5310 (muscle Group X function) and rated 10%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, with no need for separate fitness adjudications. The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating

requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s charge 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 in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB. The evidence for the bilateral plantar fasciitis is presented together, with attendant recommendations regarding separate unfitness, and separate ratings, if indicated.

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral plantar fasciitis began in April 2005 after strenuous activities and long hikes during combat training. On 29 June 2005, she was treated with over-the-counter inserts, but a year later, she noted they were no longer working. She complained of bilateral foot pain with a history of moderate/severe pes planus, and on examination, bilateral bunions and symptomatic pes planus were noted. At a primary care visit on 31 October 2006, she complained of foot pain as a result of bilateral pes planus and bunions. Bilateral ankle range of motion (ROM) measurements revealed dorsiflexion to 20 degrees (normal) and plantar flexion to 50 degrees (normal 45). Treatment consisted of a nonsteroidal anti-inflammatory drug and light duty. On 31 January 2007, she had a bunionectomy of the left first metatarsal, and on 3 October 2007, she underwent first and fifth metatarsal head chevron osteotomies for right bunion and tailor bunion corrections. Surgery provided relief of the bunion-related problems, but she continued to have bilateral plantar foot pain despite being fitted with custom orthotics.

The 10 January 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of bilateral plantar pain, rated at 7/10, that increased to 9/10 after prolonged standing; however, she no longer had bunion discomfort after the 2007 surgeries. Physical examination of each foot revealed pain at the plantar aspect of the medial longitudinal arch. There was medial plantar fascial band tightness and pain, and upon standing, there was a moderate collapse of the weight bearing arch. With ambulation, there was moderate pronation. Ankle ROM was limited to approximately 10 degrees of dorsiflexion with the knee flexed, and to less than 5 degrees with the knee straight. The examiner diagnosed bilateral flatfoot, not relieved by over-the-counter or professionally prescribed orthotics; bilateral plantar fasciitis; and “postsurgical status post bilateral bunion correction in 2007.” The prognosis noted that the only remaining treatment option was a surgical procedure to release the plantar fascial tightness in each foot. During the 23 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported pain in both feet, severe plantar fasciitis, and right/left bunionectomies. Physical examination revealed severe, symptomatic pes planus.

At the 14 May 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported bilateral flat feet with pain relieved by corrective orthotics. Physical examination showed no signs of abnormal weight bearing or breakdown, callosities, foot or toe deformities, or any unusual shoe wear pattern. The examiner noted painful motion of both feet and active motion in the metatarsophalangeal joints of the right and left great toes. There was pes planus, but no valgus noted, and the Achilles tendon was well aligned for both feet. The plantar surfaces of both feet were moderately tenderness, but with no objective findings of pain with manipulation and use of the feet. There was no forefoot or midfoot misalignment, edema, disturbed circulation, weakness, muscle atrophy, or tenderness. The examiner’s diagnosis was bilateral pes planus with subjective factors of “foot pain with prolonged standing or activity” and objective factors of “foot and ankle pain with normal [ROMs].” Pes planus with post-surgical changes was noted on bilateral foot X-rays.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated bilateral plantar fasciitis 10%, analogously coded 5399-5310, citing a moderate condition. The VA rated bilateral pes planus 0%, coded 5276 (flat foot), based on the C&P examination, citing mild symptoms relieved by built-up shoe or arch support. Panel members first considered whether the right and left foot plantar fasciitis, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. The panel greed the evidence reasonably justified that the functional limitations of each foot condition contributed to the CI’s inability to perform her military duties, and therefore determined each foot was separately unfitting, and accordingly separate disability ratings are recommended. Based on the VA examination, which was most proximate to separation, the CI’s right and left foot plantar fasciitis symptoms were ameliorated by corrective footwear and thus appeared to be slight (0%) rather than moderate for each foot. However, IAW with DoDI 6040.44, the panel may not recommend a lower combined rating than that of the PEB. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral plantar fasciitis.

Contended PEB Conditions: Postsurgical Status Bilateral Bunion Corrections. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was noted on limited duty forms, but not explicitly implicated in the non-medical assessment. As discussed above, the CI underwent bunion surgery on both feet in 2007 and had an unremarkable postoperative course with no further discomfort. There was no specific performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the bilateral plantar fasciitis and IAW VASRD §4.71a the panel recommends no change in the PEB adjudication. In the matter of the contended bilateral bunion conditions, the panel recommends no change from the PEB determination as not unfitting. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TD,
1850
CORB: 003 20May20

From:

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 7 Aug 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	

The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.